kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2016-4-110-115kpccz-244Research ArticleАКТУАЛЬНЫЕ ВОПРОСЫ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИACTUAL ISSUES OF ARTERIAL HYPERTENSIONИСПОЛЬЗОВАНИЕ ИМПЛАНТИРУЕМЫХ МОНИТОРОВ ЭКГ ДЛЯ ДИАГНОСТИКИ ПРИЧИН СИНКОПАЛЬНЫХ СОСТОЯНИЙ НЕИЗВЕСТНОГО ГЕНЕЗА У ПОДРОСТКОВ: БЛИЖАЙШИЕ РЕЗУЛЬТАТЫUTILITY OF IMPLANTABLE ECG RECORDER IN THE DIAGNOSIS OF UNEXPLAINED SYNCOPE IN ADOLESCENTS: SHORT-TERM RESULTSМАМЧУРС. Е.MAMCHURS. E.БОХАНН. С.BOKHANN. S.ХОМЕНКОЕ. А.KHOMENKOE. A.ЧИЧКОВАТ. Ю.CHICHKOVAT. Yu.

Адрес: 650002, г. Кемерово, Сосновый бульвар, 6 Тел.: 8 (3842) 64-36-80

Adress: 6, Sosnoviy blvd., Kemerovo 650002, Russian Federation Tel.: +7 (3842) 64-36-80

chi4cova@yandex.ruРОМАНОВАМ. П.ROMANOVAM. P.ШМУЛЕВИЧС. А.SHMULEVICHS. A.Федеральное государственное бюджетное научное учреждение «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний». Кемерово, РоссияРоссияFederal State Budgetary Scientific Institution Research institute for Complex Problems of Cardiovascular Diseases. Kemerovo, RussiaRussian Federation20160212201604110115Copyright © МАМЧУР С.Е., БОХАН Н.С., ХОМЕНКО Е.А., ЧИЧКОВА Т.Ю., РОМАНОВА М.П., ШМУЛЕВИЧ С.А., 20162016МАМЧУР С.Е., БОХАН Н.С., ХОМЕНКО Е.А., ЧИЧКОВА Т.Ю., РОМАНОВА М.П., ШМУЛЕВИЧ С.А.MAMCHUR S.E., BOKHAN N.S., KHOMENKO E.A., CHICHKOVA T.Y., ROMANOVA M.P., SHMULEVICH S.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/244Цель

Цель. Изучение причин синкопальных состояний неизвестного генеза у подростков по данным записей имплантируемых кардиомониторов.

Материалы и методы

Материалы и методы. В исследование включено 20 подростков в возрасте 16,4±1,1 года, страдающих синкопальными состояниями, с исключенным диагнозом кардиологической или неврологической патологии в соответствии с алгоритмом, описанным в международных рекомендациях. Им были имплантированы устройства длительного мониторирования ЭКГ Reveal XT. Длительность мониторирования составила 3,2±0,6 месяца.

Результаты

Результаты. Всеми 20 (100 %) пациентами было представлено к анализу 43 эпизода ЭКГ, записанных вручную (в среднем 2,1±0,3 на пациента) и 29 – автоматически (в среднем 1,5±0,2 на пациента). Из 43 активированных пациентами событий лишь 13 (30,2 %) были связаны с синкопальными состояниями, 8 (18,6 %) – со слабостью, 10 (23,3 %) – с головокружением, 12 (27,9 %) – с сердцебиением. Чувствительность длительного мониторирования ЭКГ в выявлении аритмогенных причин симптоматики у обследованных пациентов составила 46,3 %, положительная предсказательная точность – 59,5 %.

Выводы

Выводы. У молодых субъектов, страдающих синкопальными состояниями, необходимо выбирать агрессивную диагностическую тактику в виде имплантации им подкожных кардиомониторов.

Purpose

Purpose. Of the study was to estimate the genesis of unexplained syncope in adolescents using implantable ECG recorders.

Materials and methods

Materials and methods. Twenty adolescents 16.4±1.1 years of age with syncope were included in the study. Cardiological and neurological pathology in them was ruled out according to international guidelines. All of them underwent implantation of Reveal XT subcutaneous ECG monitors. The mean follow-up duration was 3.2±0.6 months

Results

Results. All 20 (100 %) patients have manually recorded 43 ECG episodes (the mean was 2.1±0.3 per patient). From these 43 manually activated events only 13 (30.2 %) were associated with syncope, 8 (18.6 %) with weakness, 10 (23.3 %) with vertigo, and 12 (27.9 %) with palpitations. The sensitivity of prolonged ECG monitoring in arrhythmogenic mechanism reveal was 46.3 %, the positive predictive value was 59.5 %.

Conclusion

Conclusion. In young subjects, suffering from syncope, the aggressive strategy with subcutaneous ECG recorded implantation should be chosen.

обмороксинкопальное состояниеимплантируемый кардиомониторпетлевой регистратор ЭКГfaintingsyncopeimplantable cardiac monitorECG loop recorderReferencesStephenson J. B. Syncopes and other paroxysmal events. Handb. Clin. Neurol. 2013; 112: 861–866.Stephenson J. B. Syncopes and other paroxysmal events. Handb. Clin. Neurol. 2013; 112: 861–866.Brignole M., Alboni P., Benditt D. et al. Guidelines on management (diagnosis and treatment) of syncope. Update 2004: the Task Force on Syncope, European Society of Cardiology. Europace. 2004; 6: 467–537.Brignole M., Alboni P., Benditt D. et al. Guidelines on management (diagnosis and treatment) of syncope. Update 2004: the Task Force on Syncope, European Society of Cardiology. Europace. 2004; 6: 467–537.Costantino G., Casazza G., Reed M., Bossi I., Sun B., Del Rosso A. et al. Syncope risk stratification tools vs clinical judgment: an individual patient data meta-analysis. See comment in PubMed Commons belowAm. J. Med. 2014; 127 (11): 13–25.Costantino G., Casazza G., Reed M., Bossi I., Sun B., Del Rosso A. et al. Syncope risk stratification tools vs clinical judgment: an individual patient data meta-analysis. See comment in PubMed Commons belowAm. J. Med. 2014; 127 (11): 13–25.Burkowitz J., Merzenich C., Grassme K., Bruggenjurgen B. et al. Insertable cardiac monitors in the diagnosis of syncope and the detection of atrial fibrillation: A systematic review and meta-analysis. Eur. J. Prev. Cardiol. 2016; 23 (12): 1261–1272.Burkowitz J., Merzenich C., Grassme K., Bruggenjurgen B. et al. Insertable cardiac monitors in the diagnosis of syncope and the detection of atrial fibrillation: A systematic review and meta-analysis. Eur. J. Prev. Cardiol. 2016; 23 (12): 1261–1272.Leitch J. W., Klein G. J., Yee R. et al. Syncope associated with supraventricular tachycardia: an expression of tachycardia or vasomotor response. Circulation. 1992; 85: 1064–1071.Leitch J. W., Klein G. J., Yee R. et al. Syncope associated with supraventricular tachycardia: an expression of tachycardia or vasomotor response. Circulation. 1992; 85: 1064–1071.da Silva R. M. Syncope: epidemiology, etiology, and prognosis. Front Physiol. 2014; 5: 471.da Silva R. M. Syncope: epidemiology, etiology, and prognosis. Front Physiol. 2014; 5: 471.Kapoor W. Evaluation and outcome of patients with syncope. Medicine. 1990; 69: 160–170.Kapoor W. Evaluation and outcome of patients with syncope. Medicine. 1990; 69: 160–170.Kapoor W., Hanusa B. Is syncope a risk factor for poor outcomes? Comparison of patients with and without syncope. Am. J. Med. 1996; 100: 646–655.Kapoor W., Hanusa B. Is syncope a risk factor for poor outcomes? Comparison of patients with and without syncope. Am. J. Med. 1996; 100: 646–655.Alboni P., Brignole M., Menozzi C. et al. The diagnostic value of history in patients with syncope with or without heart disease. J. Am. Coll. Cardiol. 2001; 1921–1929.Alboni P., Brignole M., Menozzi C. et al. The diagnostic value of history in patients with syncope with or without heart disease. J. Am. Coll. Cardiol. 2001; 1921–1929.Oh J. H., Hanusa B. H., Kapoor W. N. Do symptoms predict cardiac arrhythmias and mortality in patients with syncope? Arch. Intern. Med. 1999; 159: 365–373.Oh J. H., Hanusa B. H., Kapoor W. N. Do symptoms predict cardiac arrhythmias and mortality in patients with syncope? Arch. Intern. Med. 1999; 159: 365–373.Kapoor W. Evaluation and management of the patient with syncope. JAMA. 1992; 268: 2553–2560.Kapoor W. Evaluation and management of the patient with syncope. JAMA. 1992; 268: 2553–2560.Link M. S., Costeas H. F., Griffith J. L. et al. High incidence of appropriate implantable cardio-verteredefibrillator therapy in patients with syncope of unknown etiology and inducible ventricular tachycardia. J. Am. Coll. Cardiol. 1997; 29: 370–375.Link M. S., Costeas H. F., Griffith J. L. et al. High incidence of appropriate implantable cardio-verteredefibrillator therapy in patients with syncope of unknown etiology and inducible ventricular tachycardia. J. Am. Coll. Cardiol. 1997; 29: 370–375.Andrews N., Fogel R., Pelargonio G., Evans J., Prystowsky E. Implantable defibrillator event rates in patients with unexplained syncope and inducible sustained ventricular tachyarrhythmias. J. Am .Coll. Cardiol. 1999; 34: 2023–2030.Andrews N., Fogel R., Pelargonio G., Evans J., Prystowsky E. Implantable defibrillator event rates in patients with unexplained syncope and inducible sustained ventricular tachyarrhythmias. J. Am .Coll. Cardiol. 1999; 34: 2023–2030.Sciaraffia E., Chen J., Hocini M. et al. Use of event recorders and loop recorders in clinical practice: results of the European Heart Rhythm Association Survey. Europace. 2014; 16: 1384–1386.Sciaraffia E., Chen J., Hocini M. et al. Use of event recorders and loop recorders in clinical practice: results of the European Heart Rhythm Association Survey. Europace. 2014; 16: 1384–1386.Brignole M., Menozzi C., Moya A., Garcia-Civera R., Mont L., Alvarez M. et al. International Study on Syncope of Uncertain Etiology (ISSUE) Investigators. Mechanism of syncope in patients with bundle branch block and negative electrophysiological test. Circulation. 2001; 104: 2045–2050.Brignole M., Menozzi C., Moya A., Garcia-Civera R., Mont L., Alvarez M. et al. International Study on Syncope of Uncertain Etiology (ISSUE) Investigators. Mechanism of syncope in patients with bundle branch block and negative electrophysiological test. Circulation. 2001; 104: 2045–2050.Krahn A., Klein G., Norris C., Yee R. The etiology of syncope in patients with negative tilt table and electrophysiologic testing. Circulation. 1995; 92: 1819–1824.Krahn A., Klein G., Norris C., Yee R. The etiology of syncope in patients with negative tilt table and electrophysiologic testing. Circulation. 1995; 92: 1819–1824.Podoleanu C., DaCosta A., Defaye P., Taieb J., Galley D., Bru P. et al. Early use of an implantable loop recorder in syncope evaluation: a randomized study in the context of the French healthcare system (FRESH study). Arch. Cardiovasc. Dis. 2014; 107 (10): 546–552.Podoleanu C., DaCosta A., Defaye P., Taieb J., Galley D., Bru P. et al. Early use of an implantable loop recorder in syncope evaluation: a randomized study in the context of the French healthcare system (FRESH study). Arch. Cardiovasc. Dis. 2014; 107 (10): 546–552.Volosin K., Stadler R. W., Wyszynski R., Kirchof P. Tachycardia detection performance of implantable loop recorders: results from a large «real-life» patient cohort and patients with induced ventricular arrhythmias. Europace. 2013; 15: 1215–1222.Volosin K., Stadler R. W., Wyszynski R., Kirchof P. Tachycardia detection performance of implantable loop recorders: results from a large «real-life» patient cohort and patients with induced ventricular arrhythmias. Europace. 2013; 15: 1215–1222.Menozzi C., Brignole M., Garcia-Civera R., Moya A., Botto G., Tercedor L. at al. International Study on Syncope of Uncertain Etiology (ISSUE) Investigators. Mechanism of syncope in patients with heart disease and negative electrophysiologic test. Circulation. 2002; 105: 2741–2745.Menozzi C., Brignole M., Garcia-Civera R., Moya A., Botto G., Tercedor L. at al. International Study on Syncope of Uncertain Etiology (ISSUE) Investigators. Mechanism of syncope in patients with heart disease and negative electrophysiologic test. Circulation. 2002; 105: 2741–2745.Galli A., Ambrosini F., Lombardi F. Holter Monitoring and Loop Recorders: From Research to Clinical Practice. Arrhythm Electrophysiol Rev. 2016; 5 (2): 136–143.Galli A., Ambrosini F., Lombardi F. Holter Monitoring and Loop Recorders: From Research to Clinical Practice. Arrhythm Electrophysiol Rev. 2016; 5 (2): 136–143.Sulke N., Sugihara C., Hong P., Patel N., Freemantle N. The benefit of a remotely monitored implantable loop recorder as a first line investigation in un-explained syncope: the EaSyAS II trial. Europace. 2016; 18: 912–918.Sulke N., Sugihara C., Hong P., Patel N., Freemantle N. The benefit of a remotely monitored implantable loop recorder as a first line investigation in un-explained syncope: the EaSyAS II trial. Europace. 2016; 18: 912–918.Pierre B., Fauchier L., Breard L., Marie O., Poret F., Babuty D. Implantable loop recorder for recurrent syncope: influence of cardiac conduction abnormalities showing up on resting electrocardiogram and of underlying cardiac disease on follow up developments. Europace. 2008; 10: 477–481.Pierre B., Fauchier L., Breard L., Marie O., Poret F., Babuty D. Implantable loop recorder for recurrent syncope: influence of cardiac conduction abnormalities showing up on resting electrocardiogram and of underlying cardiac disease on follow up developments. Europace. 2008; 10: 477–481.Solbiati M., Costantino G., Casazza G., Dipaola F., Galli A., Furlan R. et al. Implantable loop recorder versus conventional diagnostic workup for unexplained recurrent syncope. Cochrane Database Syst. Rev. 2016; 4. DOI: 10.1002/14651858.CD011637.pub2.Solbiati M., Costantino G., Casazza G., Dipaola F., Galli A., Furlan R. et al. Implantable loop recorder versus conventional diagnostic workup for unexplained recurrent syncope. Cochrane Database Syst. Rev. 2016; 4. DOI: 10.1002/14651858.CD011637.pub2.Krahn A., Klein G. J., Yee R., Skanes A. C. Randomized assessment of syncope trial. Conventional diagnostic testing versus a prolonged monitoring strategy. Circulation. 2001; 104: 46–51.Krahn A., Klein G. J., Yee R., Skanes A. C. Randomized assessment of syncope trial. Conventional diagnostic testing versus a prolonged monitoring strategy. Circulation. 2001; 104: 46–51.

The authors declare that there are no conflicts of interest present.