Pietro Palmisano1, Pier Luigi Pellegrino2, Ernesto Ammendola3, Matteo Ziacchi4, Federico Guerra5, Vittorio Aspromonte6, Mattia Laffi7, Lorenzo Pimpini8, Francesco Santoro9,10, Enrico Boggio11, Alessandro Guido1, Giuseppe Patti11, Natale Daniele Brunetti10, Gerardo Nigro3, Mauro Biffi4, Antonio Dello Russo5, Germano Gaggioli7, Michele Accogli1, Gabriele Dell'Era11. 1. Cardiology Unit, "Card. G. Panico" Hospital, Tricase, Italy. 2. Cardiology Department, Policlinico Riuniti University Hospital, Foggia, Italy. 3. Dipartimento di Cardiologia, Università della Campania - L.Vanvitelli, Ospedale Monaldi, Napoli, Italy. 4. Institute of Cardiology, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy. 5. Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Umberto I-Lancisi-Salesi", Ancona, Italy. 6. Cardiology - Coronary Care Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy. 7. Cardiology Division, Villa Scassi Hospital, Genova, ASL 3, Genova, Italy. 8. Unit of Cardiology-CCU, Italian National Reserch Centre on Aging, Ancona, Italy. 9. Department of Cardiology, Bonomo Hospital, Andria, Italy. 10. Department of Medical and Surgery Sciences, University of Foggia, Foggia, Italy. 11. Division of Cardiology, Azienda Ospedaliera Universitaria "Maggiore della Carità", Novara, Italy.
Abstract
AIMS: To evaluate the risk of syncopal recurrences after pacemaker implantation in a population of patients with syncope of suspected bradyarrhythmic aetiology. METHODS AND RESULTS: Prospective, multicentre, observational registry enrolling 1364 consecutive patients undergoing pacemaker implantation for syncope of bradyarrhythmic aetiology (proven or presumed). Before pacemaker implantation, all patients underwent a cardiac work-up in order to establish the bradyarrhythmic aetiology of syncope. According to the results of the diagnostic work-up, patients were divided into three groups: Group A, patients in whom a syncope-electrocardiogram (ECG) correlation was established (n = 329, 24.1%); Group B, those in whom clinically significant bradyarrhythmias were detected without a documented syncope-ECG correlation (n = 877, 64.3%); and Group C, those in whom bradyarrhythmias were not detected and the bradyarrhythmic origin of syncope remained presumptive (n = 158, 11.6%). During a median follow-up of 50 months, 213 patients (15.6%) reported at least one syncopal recurrence. Patients in Groups B and C showed a significantly higher risk of syncopal recurrences than those in Group A [hazard ratios (HRs): 1.60 and 2.66, respectively, P < 0.05]. Failure to establish a syncope-ECG correlation during diagnostic work-up before pacemaker implantation was an independent predictor of syncopal recurrence on multivariate analysis (HR: 1.90; P = 0.002). CONCLUSION: In selecting patients with syncope of suspected bradyarrhythmic aetiology for pacemaker implantation, establishing a correlation between syncope and bradyarrhythmias maximizes the efficacy of pacing and reduces the risk of syncopal recurrences. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To evaluate the risk of syncopal recurrences after pacemaker implantation in a population of patients with syncope of suspected bradyarrhythmic aetiology. METHODS AND RESULTS: Prospective, multicentre, observational registry enrolling 1364 consecutive patients undergoing pacemaker implantation for syncope of bradyarrhythmic aetiology (proven or presumed). Before pacemaker implantation, all patients underwent a cardiac work-up in order to establish the bradyarrhythmic aetiology of syncope. According to the results of the diagnostic work-up, patients were divided into three groups: Group A, patients in whom a syncope-electrocardiogram (ECG) correlation was established (n = 329, 24.1%); Group B, those in whom clinically significant bradyarrhythmias were detected without a documented syncope-ECG correlation (n = 877, 64.3%); and Group C, those in whom bradyarrhythmias were not detected and the bradyarrhythmic origin of syncope remained presumptive (n = 158, 11.6%). During a median follow-up of 50 months, 213 patients (15.6%) reported at least one syncopal recurrence. Patients in Groups B and C showed a significantly higher risk of syncopal recurrences than those in Group A [hazard ratios (HRs): 1.60 and 2.66, respectively, P < 0.05]. Failure to establish a syncope-ECG correlation during diagnostic work-up before pacemaker implantation was an independent predictor of syncopal recurrence on multivariate analysis (HR: 1.90; P = 0.002). CONCLUSION: In selecting patients with syncope of suspected bradyarrhythmic aetiology for pacemaker implantation, establishing a correlation between syncope and bradyarrhythmias maximizes the efficacy of pacing and reduces the risk of syncopal recurrences. Published on behalf of the European Society of Cardiology. All rights reserved.