Dual-Chamber Pacing With Closed Loop Stimulation in Recurrent Reflex Vasovagal Syncope
| Autor: | Encarnación Gutiérrez-Carretero, Ricardo Ruiz-Granell, Javier Lacunza-Ruiz, Rafael Romero-Garrido, Roberto Garcia-Civera, Jesús Martínez-Alday, Àngel Moya-Mitjans, Gonzalo Barón-Esquivias, Carlos A. Morillo |
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| Rok vydání: | 2017 |
| Předmět: |
biology
business.industry Hazard ratio Syncope (genus) 030204 cardiovascular system & hematology medicine.disease biology.organism_classification Confidence interval Closed loop stimulation 03 medical and health sciences 0302 clinical medicine Anesthesia medicine Reflex 030212 general & internal medicine Asystole Cardiology and Cardiovascular Medicine business Vasovagal syncope First Recurrence |
| Zdroj: | Journal of the American College of Cardiology. 70:1720-1728 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2017.08.026 |
| Popis: | Background Pacing in vasovagal syncope remains controversial. Objectives The authors evaluated dual-chamber pacing with closed loop stimulation (DDD-CLS) in patients with cardioinhibitory vasovagal syncope. Methods This randomized, double-blind, controlled study included Canadian and Spanish patients age ≥40 years, with high burden syncope (≥5 episodes, ≥2 episodes in the past year), and a cardioinhibitory head-up tilt test (bradycardia 3 s). Patients were randomized to either DDD-CLS pacing for 12 months followed by sham DDI mode pacing at 30 pulses/min for 12 months (group A), or sham DDI mode for 12 months followed by DDD-CLS pacing for 12 months (group B). Patients in both arms crossed-over after 12 months of follow-up or when a maximum of 3 syncopal episodes occurred within 1 month. Results A total of 46 patients completed the protocol; 22 were men (47.8%), and mean age was 56.30 ± 10.63 years. The mean number of previous syncopal episodes was 12 (range 9 to 20). The proportion of patients with ≥50% reduction in the number of syncopal episodes was 72% (95% confidence interval [CI]: 47% to 90%) with DDD-CLS compared with 28% (95% CI: 9.7% to 53.5%) with sham DDI mode (p = 0.017). A total of 4 patients (8.7%) had events during DDD-CLS and 21 (45.7%) during sham DDI (hazard ratio: 6.7; 95% CI: 2.3 to 19.8). Kaplan-Meier curve was significantly different between groups in time to first syncope: 29.2 months (95% CI: 15.3 to 29.2 months) versus 9.3 months (95% CI: 6.21 months, NA; p Conclusions DDD-CLS pacing significantly reduced syncope burden and time to first recurrence by 7-fold, prolonging time to first syncope recurrence in patients age ≥40 years with head-up tilt test–induced vasovagal syncope compared with sham pacing. (Closed Loop Stimulation for Neuromediated Syncope [SPAIN Study]; NCT01621464) |
| Databáze: | OpenAIRE |
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