晕厥诊断长时程心电记录仪的应用与评价.ppt

Brignole M, Sutton R, Menozzi C, Garcia-Civera R, Moya A, Wieling W, Andresen D, Benditt DG, Vardas P. Early application of an implantable loop recorder allows a mechanism-based effective therapy in patients with recurrent suspected neurally mediated syncope. Eur Heart J 2006;27:1085–1092 ISSUE2：结 论 早期应用ILR的新诊断策略 提供一种安全的危险分层方法 有助于制定有效的治疗方案 倾斜试验和ATP试验在指导针对性的治疗上几乎没有价值 Recurrent Unexplained Palpitations (RUP) Study1 Giada F. et al. Recurrent unexplained palpitations (RUP) study comparison of implantable loop recorder versus conventional diagnostic strategy. J Am Coll Cardiol 2007 May 15;49(19):1951-6. Based on an exchange rate of €1.5 to $1. 50 patients with infrequent sustained palpitations were randomized either to a conventional external monitoring strategy or to Reveal ILR Diagnosis was obtained in 21% of the conventional group and 73% of the ILR group, with significantly lower cost per diagnosis in the ILR group ($4,584 vs. $10,152)2 PacemakerTherapy inPatients With Neurally MediatedSyncope and Documented AsystoleThird International Study on Syncope of Uncertain Etiology (ISSUE-3) A Randomized Trial Circulation.2012;125:2566-2571 Time to first recurrence of syncope according to the intention-to-treat analysis 75% 43% 绝对风险下降：32% 相对风险下降：57% Circulation.2012;125:2566-2571 Prolonged implantable electrocardiographicmonitoring indicates a high rate of misdiagnosisof epilepsy-REVISE study Europace(2012) 14,1653--1660 Prolonged implantable electrocardiographicmonitoring indicates a high rate of misdiagnosisof epilepsy-REVISE study Europace(2012) 14,1653--1660 22例 Prolonged implantable electrocardiographicmonitoring indicates a high rate of misdiagnosisof epilepsy-REVISE study 22例/103例（21.4%）发现有心动过缓，21例接受了起搏治疗。 22例中，50%的患者（6例/Pro组，5例/Retro组）以前是确诊为癫痫。 17例/22例（81%）植入起搏器后（其中4例还在服抗癫痫药），症状消失。 13例/103例（12.6%）的诊断为癫痫的患者，植入起搏器后症状消失。 Europace(2012) 14,1653--1660 Prolonged implantable electrocardiographicmonitoring indicates a high rate of misdiagnosisof epileps