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Notagildi ígræddra taktnema við mat á óútskýrðu yfirliði og hjartsláttaróþægindum

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Authors
Ingibjörg Kristjánsdóttir
Guðrún Reimarsdóttir
Davíð O. Arnar,
Issue Date
2012-09

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Other Titles
The usefullness of implantable loop recorders for evaluation of unexplained syncope and palpitations
Citation
Læknablaðið 2012, 98(9):465-8
Abstract
Syncope is a common complaint and determining the underlying cause can be difficult despite extensive evaluation. The purpose of this study was to evaluate the usefulness of an implantable loop recorder for patients with unexplained syncope and palpitations. This was a retrospective analysis of 18 patients, five of whom still have the device implanted. All patients had undergone extensive evaluation for their symptoms before getting the loop recorder implanted and this was therefore a highly select group. Of the thirteen patients where use of the device was completed, the mean age was 65±20 years. The loop recorder was in use for a mean time of 20±13 months. Unexplained syncope, eleven of thirteen, was the most common indication. The other two received the loop recorder for unexplained palpitations. Four patients had sick sinus syndrome during monitoring, three had supraventricular tachycardia and one had ventricular tachycardia. Further three had typical symptoms but no arrhythmia was recorded and excluding that as a cause. Two patients had no symptoms the entire time they had the loop recorder. Of the five patients still with the device three had syncope as the indication for monitoring and two have the device as a means of evaluating the results of treatment for arrhythmia. This study on our initial experience with implantable loop recorders shows that these devices can be useful in the investigation of the causes of syncope and palpitations.
Yfirlið eru algeng og getur reynst erfitt að greina orsök þeirra. Markmið rannsóknarinnar var að kanna frumárangur af notkun ígræddra taktnema við mat á orsökum óútskýrðra yfirliða og hjartsláttarþæginda. Efniviður/aðferðir: Rannsóknin var afturskyggn og náði til 18 sjúklinga sem fengið hafa ígræddan taktnema hérlendis. Af þessum 18 eru 5 enn með tækið ígrætt og ekki komin endanleg niðurstaða af vöktun hjartatakts hjá þeim. Þessir sjúklingar höfðu farið í gegnum ítarlegar rannsóknir án þess að skýring hefði fundist og var því um valinn hóp einstaklinga að ræða. Af þeim 13 sjúklingum þar sem vöktun hjartatakts var lokið var meðalaldur 65±20 ára. Í öllum tilfellum nema einu var taktnemi hafður inni þar til skýring á einkennum var fundin eða rafhlaða kláraðist, meðaltími í sjúklingi var 20±13 mánuðir. Óútskýrt yfirlið var algengasta ábendingin, eða hjá 11 sjúklingum, en hjá hinum tveimur var tækið sett inn vegna óútskýrðra hjartsláttaróþæginda. Hjá fjórum fannst merki um sjúkan sinushnút, hjá þremur ofansleglahraðtaktur og í einu tilfelli sleglahraðtaktur. Hjá þremur sjúklingum var hægt að útiloka truflun á hjartatakti sem orsök einkenna þar sem reglulegur sinustaktur sást samfara dæmigerðum einkennum. Tveir sjúklingar fengu engin einkenni á meðan þeir voru með taktnemann. Af þeim 5 sjúklingum sem eru enn með taktnemann inni og vöktun enn í gangi var ábendingin yfirlið hjá þremur en hjá tveimur er tækið notað til að fylgjast með árangri meðferðar á hjartsláttartruflunum. Þessar frumniðurstöður sýna fram á skýran ávinning af notkun ígrædds taktnema við rannsóknir á óútskýrðum yfirliðum og hjartsláttaróþægindum.
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