Is a pacemaker indicated for vasovagal patients with severe cardioinhibitory reflex as identified by the ATP test?. A preliminary randomized trial
| Autor: | Daniel Flammang, Djamel Hamani, Erwan Donal, A. Chassing, M Antiel, T Church, M. Waynberger |
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| Rok vydání: | 1999 |
| Předmět: |
Male
Pacemaker Artificial medicine.medical_specialty law.invention Electrocardiography Adenosine Triphosphate Randomized controlled trial Recurrence Risk Factors law Physiology (medical) Internal medicine Syncope Vasovagal medicine ATP test Humans Vasovagal syncope Aged medicine.diagnostic_test business.industry Heart medicine.disease Cardiovascular physiology Electrophysiology Clinical trial Reflex Cardiology Artificial cardiac pacemaker Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Europace. 1:140-145 |
| ISSN: | 1099-5129 |
| DOI: | 10.1053/eupc.1998.0021 |
| Popis: | BACKGROUND: A previous observational study suggested that, in syncopal elderly patients with vasovagal syndrome, a test using adenosine-5'-triphosphate (intravenous ATP 20 mg. 2 ml-1) could identify a subgroup of patients at high risk of severe cardioinhibitory response and guide the therapeutic strategy. To test one aspect of these results prospectively, we designed a small study focusing only on vasovagal patients with abnormal response to ATP testing. METHODS: Twenty patients hospitalized for syncope, which was considered to be vasovagal, and exhibiting an abnormal ATP test--defined by a longer than 10 s cardiac pause--were randomized to two groups: half to implantation with a dual-chamber pacemaker and half to usual medical care. All patients who were not hospitalized for recurrences were assessed every 6 months in the clinic or by telephone. RESULTS: At baseline, the randomized patient groups were similar in their demographic and health characteristics and in the results of their ATP tests, for example the mean cardiac pause (21.4 +/- 9.3 vs 15.9 +/- 3.7 s) and the mean interval between escape beats during the pause (7.29 +/- 4.2 vs 7.48 +/- 3.3 s). During a mean follow-up of 52 months, recurrences appeared in six of the 10 usual-care patients (range 0.2-29 months) but in none of the implanted patients (P < 0.02). CONCLUSIONS: This limited trial (1) supports the conclusion that patients with an abnormal ATP test who receive a dual-chamber pacemaker suffer fewer recurrences than those who are monitored only; and (2) consequently further supports the hypothesis that, among vasovagal patients, a cardiac pause of longer than 10 s in patients administered ATP identifies those at high risk of symptomatic vagal cardiac inhibition. |
| Databáze: | OpenAIRE |
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