Causes of syncopal recurrences in patients treated with permanent pacing for bradyarrhythmic syncope: Findings from the SYNCOPACED registry

Palmisano, Pietro; Dell’Era, Gabriele; Pellegrino, Pier Luigi; Ammendola, Ernesto; Ziacchi, Matteo; Guerra, Federico; Aspromonte, Vittorio; Laffi, Mattia; Pimpini, Lorenzo; Santoro, Francesco; Boggio, Enrico; Guido, Alessandro; Patti, Giuseppe; Brunetti, Natale Daniele; Nigro, Gerardo; Biffi, Mauro; Russo, Antonio Dello; Gaggioli, Germano; Accogli, Michele; Pacing, Cardiac

doi:10.1016/j.hrthm.2021.01.010

Cited by 9 publications

(6 citation statements)

References 24 publications

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“…Fractures of the sternum can occur as a result of chronic mechanical stress or acute traumatic force applied to the thoracic area. The device may incur damages from different factors, including exposure to moisture or high temperatures [ 21 – 24 , 35 ]. Software-related problems have the potential to cause malfunctions in cardiac implantable electronic devices (CIEDs).…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review and Meta-analysis of the Prevalence and Risk Factors in Cardiac Implantable Electronic Device Malfunction

Saeed,

AlShafea,

AlQthami

et al. 2023

Journal of the Saudi Heart Association

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Introduction Cardiac implantable electronic devices (CIED) include permanent pacemakers (PPMs), implantable cardioverter defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices. They treat several cardiac issues and are dependent on batteries; however, similar to any medical equipment, they can fail. The prevalence and risk factors for CIED malfunction must be understood for earlier detection and better patient outcomes. Material and methods A comprehensive search was conducted through electronic bibliographic sources (PubMed and Cochrane) until January 2023 in order to identify reviews, cohort studies and case reports pertaining to CIED. The primary outcome is the probability of CIED malfunction. The secondary outcome concerned significant risk factors. Two authors independently extracted articles by utilizing pre-established data fields. Using a random-effects model, the aggregated prevalence and 95 % confidence intervals (CIs) were computed. Results The meta-analysis comprised eight review articles, twenty-two retrospective studies, and thirty-seven case reports from the systematic review. The eight review articles contained a CIED malfunction of 4.03 % (random-effects model). The pooled prevalence of CIED malfunction in the meta-analysis of 22 retrospective studies was 0.41 percent (using a fixed-effects model) and 8.01 percent (using a random-effects model). Moreover, age, pre-existing cardiac conditions, CIED type, lead placement, and medical device interactions all contributed to an increase in the heterogeneity (I2 = 98.90 %) of the risk of CIED malfunction. Conclusion CIED malfunction is common and more likely to occur in elderly individuals and in certain types of CIED. Clinicians should focus on risk factors and closely monitor the patients with higher probability for CIED malfunction with short intervals.

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Section: Resultsmentioning

confidence: 99%

A Systematic Review and Meta-analysis of the Prevalence and Risk Factors in Cardiac Implantable Electronic Device Malfunction

Saeed,

AlShafea,

AlQthami

et al. 2023

Journal of the Saudi Heart Association

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“… 20 In a more recent registry-based study including patients undergoing a pacemaker implantation for bradyarrhythmia syncope, the cumulative incidence of syncope recurrence was 15.6%, as well as 12.5% with restriction to patients with sinus node dysfunction. 22 Common causes were reflex syncope (30%) and orthostatic hypotension (32%). In the present study, the rate of syncope or presyncope was comparable with previous reports for patients randomized to DDDR-60 but it was markedly higher for patients randomized to DDD-40.…”

Section: Discussionmentioning

confidence: 99%

Atrial pacing minimization in sinus node dysfunction and risk of incident atrial fibrillation: a randomized trial

Kronborg,

Frausing,

Malczynski

et al. 2023

European Heart Journal

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Background and Aims High percentages of atrial pacing have been associated with an increased risk of atrial fibrillation. This study is aimed at evaluating whether atrial pacing minimization in patients with sinus node dysfunction reduces the incidence of atrial fibrillation. Methods In a nationwide, randomized controlled trial, 540 patients with sinus node dysfunction and an indication for first pacemaker implantation were assigned to pacing programmed to a base rate of 60 bpm and rate-adaptive pacing (DDDR-60) or pacing programmed to a base rate of 40 bpm without rate-adaptive pacing (DDD-40). Patients were followed on remote monitoring for 2 years. The primary endpoint was time to first episode of atrial fibrillation longer than 6 min. Secondary endpoints included longer episodes of atrial fibrillation, and the safety endpoint comprised a composite of syncope or presyncope. Results The median percentage of atrial pacing was 1% in patients assigned to DDD-40 and 49% in patients assigned to DDDR-60. The primary endpoint occurred in 124 patients (46%) in each treatment group (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.76–1.25, P = .83). There were no between-group differences in atrial fibrillation exceeding 6 or 24 h, persistent atrial fibrillation, or cardioversions for atrial fibrillation. The incidence of syncope or presyncope was higher in patients assigned to DDD-40 (HR 1.71, 95% CI 1.13–2.59, P = .01). Conclusions Atrial pacing minimization in patients with sinus node dysfunction does not reduce the incidence of atrial fibrillation. Programming a base rate of 40 bpm without rate-adaptive pacing is associated with an increased risk of syncope or presyncope.

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“…After PPM implantation, there remains a risk for syncope recurrence in bradyarrhythmic syncope patients including patients with syncope and BFB, with a recent study indicating 15.6% recurrence at 50 months follow-up [19]. The risk of syncope recurrence is highest for patients who underwent PPM placement for vasovagal syncope (26.4%) followed by patients with unexplained syncope and chronic BFB (21.5%) [19]. Overall, the most common cause of recurrence was reflex syncope (27.7%), followed by orthostatic hypotension (26.3%).…”

Section: Discussionmentioning

confidence: 99%

“…Overall, the most common cause of recurrence was reflex syncope (27.7%), followed by orthostatic hypotension (26.3%). However, in patients with PPM placement for syncope and BFB, 29.4% of recurrences remained unexplained while 26.5% of recurrences were due to reflex syncope [19]. The risk of recurrence mandates a discussion of risks and benefits, before PPM implantation for patients with syncope, first-degree AVB, and BFB.…”

Section: Discussionmentioning

confidence: 99%

Bedside Carotid Sinus Massage for Syncope Evaluation With Bifascicular Block and First-Degree Atrioventricular Block

Badshah¹,

Shaukat²,

Birlas³

et al. 2023

Cureus

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Symptomatic bifascicular block (BFB) with a reversible high-grade atrioventricular block (AVB) is an overlooked cause of syncope with differing diagnostic and therapeutic approaches. We present a case of a 79-year-old gentleman with multiple episodes of cardiac syncope. Initial electrocardiogram revealed a left bundle branch block and first-degree AVB worsened by bedside carotid sinus massage (CSM) obviating the need for electrophysiologic (EP) studies or continuous electrocardiographic monitoring for further evaluation. This case highlights the importance of CSM as a useful clinical tool in addition to EP studies and internal loop recorder (ILR) placement for assessment and appropriateness of permanent pacemaker (PPM) implantation. It also sheds light on the differing management protocols between EP studies and ILR evaluation versus empiric PPM implantation for patients with cardiac syncope secondary to BFB and AVB.

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Causes of syncopal recurrences in patients treated with permanent pacing for bradyarrhythmic syncope: Findings from the SYNCOPACED registry

Cited by 9 publications

References 24 publications

A Systematic Review and Meta-analysis of the Prevalence and Risk Factors in Cardiac Implantable Electronic Device Malfunction

A Systematic Review and Meta-analysis of the Prevalence and Risk Factors in Cardiac Implantable Electronic Device Malfunction

Atrial pacing minimization in sinus node dysfunction and risk of incident atrial fibrillation: a randomized trial

Bedside Carotid Sinus Massage for Syncope Evaluation With Bifascicular Block and First-Degree Atrioventricular Block

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