Registadores de Eventos Implantados no Diagnóstico de Síncope
DOI:
https://doi.org/10.24950/rspmi/Revisao/63/18/2/2019Palavras-chave:
Diagnóstico por Computador, Monitorização Ambulatorial, Síncope/diagnósticoResumo
No diagnóstico de pacientes com síncope é fundamental
que a etiologia seja determinada corretamente. Desta forma,
na avaliação destes doentes é essencial uma abordagem
multifacetada, combinando uma história clínica meticulosa
com um exame físico e exames auxiliares de diagnóstico
adequados. No entanto, mesmo com uma correta abordagem inicial, muitos pacientes são mal diagnosticados ou
permanecem sem diagnóstico, tornando-se assim candidatos a um seguimento prolongado.
O implantable loop recorder (ILR) é um aparelho de pequenas dimensões que permite uma monitorização prolongada
(até 3 anos) da atividade elétrica cardíaca, aumentando a
probabilidade de detetar uma correlação entre eventuais
alterações do ritmo cardíaco e os sintomas do paciente. Assim, os ILR têm assumido um interesse crescente nesta área
dado que permitem detetar a etiologia cardíaca (arrítmica)
de muitas síncopes que até então permaneciam de causa
desconhecida.
As guidelines atuais recomendam o uso dos ILRs na fase
precoce da avaliação de pacientes com síncopes recorrentes de causa desconhecida, após avaliação inicial, na ausência de critérios de alto risco e na avaliação de pacientes
de alto risco com síncope após avaliação inicial negativa.
Este artigo é uma revisão sistemática que resume o conhecimento atual sobre a utilidade e a precisão dos ILRs no
diagnóstico de síncope de causa desconhecida após uma
abordagem diagnóstica convencional, tal como a sua utilidade em diversas situações específicas (na epilepsia, na
população pediátrica, em idosos, na fibrilação auricular e no
AVC criptogénico).
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