Michele Brignole1, Fabrizio Ammirati2, Francesco Arabia3, Fabio Quartieri4, Marco Tomaino5, Andrea Ungar6, Maurizio Lunati7, Vitantonio Russo8, Attilio Del Rosso9, Germano Gaggioli10. 1. Arrhythmology Centre, Department of Cardiology, Ospedali del Tigullio, 16033 Lavagna, Italy mbrignole@asl4.liguria.it. 2. Ospedale 'GB Grassi', Ostia, Italy. 3. Ospedale Pugliese Ciaccio, Catanzaro, Italy. 4. Arcispedale S. Maria Nuova, Reggio Emilia, Italy. 5. Ospedale Generale Regionale, Bolzano, Italy. 6. Ospedale Careggi, Firenze, Italy. 7. Ospedale Niguarda Ca' Granda, Milano, Italy. 8. Ospedale SS. Annunziata, Taranto, Italy. 9. Ospedale S. Giuseppe, Empoli, Italy. 10. Ospedale Villa Scassi, Genova, Italy.
Abstract
AIMS: Opinions differ regarding the effectiveness of cardiac pacing in patients affected by reflex syncope. We assessed a standardized guideline-based algorithm in different forms of reflex syncope. METHODS AND RESULTS: In this prospective, multi-centre, observational study, patients aged >40 years, affected by severe unpredictable recurrent reflex syncopes, underwent carotid sinus massage (CSM), followed by tilt testing (TT) if CSM was negative, followed by implantation of an implantable loop recorder (ILR) if TT was negative. Those who had an asystolic response to one of these tests received a dual-chamber pacemaker. POPULATION: 253 patients, mean age 70 ± 12 years, median 4 (3-6) syncopes, 89% without or with short prodromes. Of these patients, 120 (47%) received a pacemaker and 106 were followed up for a mean of 13 ± 7 months: syncope recurred in 10 (9%). The recurrence rate was similar in 61 CSM+ (11%), 30 TT+ (7%), and 15 ILR+ (7%) patients. The actuarial total syncope recurrence rate was 9% (95% confidence interval (CI), 6-12) at 1 year and 15% (95% CI, 10-20) at 2 years and was significantly lower than that observed in the group of 124 patients with non-diagnostic tests who had received an ILR: i.e. 22% (95% CI, 18-26) at 1 year and 37% (95% CI, 30-43) at 2 years (P = 0.004). CONCLUSION: About half of older patients with severe recurrent syncopes without prodromes have an asystolic reflex for which cardiac pacing goes along with a low recurrence rate. The study supports the clinical utility of the algorithm for the selection of candidates to cardiac pacing in everyday clinical practice. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01509534. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Opinions differ regarding the effectiveness of cardiac pacing in patients affected by reflex syncope. We assessed a standardized guideline-based algorithm in different forms of reflex syncope. METHODS AND RESULTS: In this prospective, multi-centre, observational study, patients aged >40 years, affected by severe unpredictable recurrent reflex syncopes, underwent carotid sinus massage (CSM), followed by tilt testing (TT) if CSM was negative, followed by implantation of an implantable loop recorder (ILR) if TT was negative. Those who had an asystolic response to one of these tests received a dual-chamber pacemaker. POPULATION: 253 patients, mean age 70 ± 12 years, median 4 (3-6) syncopes, 89% without or with short prodromes. Of these patients, 120 (47%) received a pacemaker and 106 were followed up for a mean of 13 ± 7 months: syncope recurred in 10 (9%). The recurrence rate was similar in 61 CSM+ (11%), 30 TT+ (7%), and 15 ILR+ (7%) patients. The actuarial total syncope recurrence rate was 9% (95% confidence interval (CI), 6-12) at 1 year and 15% (95% CI, 10-20) at 2 years and was significantly lower than that observed in the group of 124 patients with non-diagnostic tests who had received an ILR: i.e. 22% (95% CI, 18-26) at 1 year and 37% (95% CI, 30-43) at 2 years (P = 0.004). CONCLUSION: About half of older patients with severe recurrent syncopes without prodromes have an asystolic reflex for which cardiac pacing goes along with a low recurrence rate. The study supports the clinical utility of the algorithm for the selection of candidates to cardiac pacing in everyday clinical practice. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01509534. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Ashish Chaddha; Martina Rafanelli; Michele Brignole; Richard Sutton; Kevin E Wenzke; Stephen L Wasmund; Richard L Page; Mohamed H Hamdan Journal: Clin Auton Res Date: 2016-06-20 Impact factor: 4.435
Authors: Richard Sutton; Jelle S Y de Jong; Julian M Stewart; Artur Fedorowski; Frederik J de Lange Journal: Heart Rhythm Date: 2020-02-06 Impact factor: 6.343