Closed‐looped stimulation cardiac pacing for recurrent vasovagal syncope: A systematic review and meta‐analysis

Abstract

BackgroundVasovagal syncope (VVS) is defined by transient loss of consciousness with spontaneous rapid recovery. Recently, a closed‐loop stimulation pacing system (CLS) has shown superior effectiveness to conventional pacing in refractory VVS. However, systematic review and meta‐analysis has not been performed. We assessed the impact of CLS implantation and reduction in recurrent VVS events by a systematic review and a meta‐analysis.MethodsWe comprehensively searched the databases of MEDLINE and EMBASE from inception to September 2017. Included studies were published prospective or retrospective cohort, randomized controlled trial, and case–control studies that compared VVS events between recurrent, severe, or refractory cardioinhibitory VVS patient implanted with CLS and conventional pacing. Data from each study were combined using the random‐effects, generic inverse variance method of DerSimonian and Laird to calculate odds ratios and 95% confidence intervals.ResultsSix studies from November 2004 to October 2017 were included in this meta‐analysis involving 224 recurrent, severe, or refractory cardioinhibitory VVS patients implanted with CLS and 163 recurrent, severe, or refractory VVS patients implanted with conventional pacing. CLS significantly reduced recurrent VVS events compared to conventional pacing (pooled odds ratio = 0.23, 95% confidence interval: 0.13‐0.39, P = 0.000, I 2 = 36.5%) as well as subgroup of four randomized controlled trial studies (pooled odds ratio = 0.28, 95% confidence interval: 0.17‐0.44, P = 0.000, I 2 = 39.2%).ConclusionClosed‐loop stimulation significantly reduced recurrent VVS events up to 80% when compared to conventional pacing. Our study suggests that CLS is an effective tool for preventing syncope recurrences in patients with recurrent, severe, or refractory cardioinhibitory VVS.

Cardiac pacing in vasovagal syncope in the light of the latest recommendations

“…6 www.journals.viamedica.pl/folia_cardiologica of patients in the DDD-CLS group compared to 28% (95% CI 9.7-53.5%) of patients in the DDI group (p = 0.017) [23]. In a metaanalysis that compared conventional pacing with CLS-based pacing in patients with recurrent VVS (6 studies, 224 patients), a clear superiority of CLSbased pacing was shown [24]. Similar results were obtained when CLS-based pacing was compared with RDR--based pacing (a meta-analysis of 5 studies, n = 228) [25].…”

Rate-Responsive Cardiac Pacing: Technological Solutions and Their Applications

“…Due to the principle underlying the CLS sensor, it characteristically reduces symptoms associated with syncope in patients with vasovagal syndrome. Several clinical trials have evaluated the use of CLS in patients with vasovagal reflex syncope, with a mean follow-up of 30 months, and 88% of patients experienced a reduction in symptoms associated with vasovagal syndrome after using CLS [ 102 , 103 , 104 , 105 ].…”

Electrocardiographic Patterns in Patients with Neurally Mediated Syncope

“…TTT can be used to unmask NMS, and the results can predict response of cardiac pacing in NMS [ 21 , 22 ]. Asystolic tilt response shows the major role of CI reflex in NMS and predicts asystolic spontaneous syncope, and thus the response to DDD-CLS (closed loop stimulation) pacing in reducing the syncope burden and syncope recurrence [ 23 , 24 , 25 , 26 , 27 ]. It was observed that in patients with NMS, in spite of DDD-CLS stimulation, prodromal symptoms were still present.…”