Pacing therapy in the management of unexplained syncope: a tertiary care centre prospective study

Yasa, Ekrem; Ricci, Fabrizio; Holm, Hannes; Persson, Torbjörn; Melander, Olle; Sutton, Richard; Hamrefors, Viktor; Fedorowski, Artur

doi:10.1136/openhrt-2019-001015

Cited by 14 publications

(7 citation statements)

References 29 publications

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“…Assessment of cardiovascular autonomic function and reflex syncope susceptibility gives several distinct patient management advantages: confirmation of diagnosis by reproduction of spontaneous symptoms of VVS on tilt [ 6 ] patient education about prodromes and counter-pressure maneuvers on tilt in VVS [ 6 ] a basis for pacemaker selection in VVS [ 7 ], prognostic information with respect to future syncope recurrence, especially in the context of pacing therapy [ 8 ] a diagnosis of carotid sinus syndrome which may call for a different pacemaker program [ 1 ], understanding the role of the vasodepressor component in both CSS and VVS implying a possible reduction in hypotensive medication or even addition of medication to support blood pressure [ 9 ], diagnosis of OH by active standing and delayed OH by tilt [ 1 , 10 , 11 ]. …”

Section: Discussionmentioning

confidence: 99%

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Outcomes of Primary vs. Delayed Strategy of Implanting a Cardiac Monitor for Unexplained Syncope

Yasa

Intzilakis

Ricci

et al. 2022

JCM

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Objective: Implantable cardiac monitors (ILR) have an important role in diagnosing unexplained syncope. However, outcomes of primary vs. delayed ILR implantation after initial syncope evaluation have not been explored. Methods: A total of 1705 patients with unexplained syncope were prospectively enrolled in the SYSTEMA (Syncope Study of Unselected Population in Malmö) cohort. Patients who underwent cardiovascular autonomic testing (CAT) and ILR were grouped into those referred to CAT after ILR implantation (primary ILR) and those in whom ILR was indicated after CAT (post-CAT ILR). Results: One-hundred-and-fifteen patients (6.7%) received ILRs. ILR recipients were older (58 vs. 52 years; p = 0.002), had more syncope recurrences (6 vs. 4; p < 0.001), more traumatic falls (72% vs. 53%; p < 0.001), and less prodrome (40% vs. 55%; p = 0.005) than patients without ILRs. During follow-up ≥16 months after ILR, 67 (58%) had normal sinus rhythm, 10 (8.7%) had sinus arrest, 10 (8.7%) AV-block, 13 (11.3%) atrial fibrillation, 9 (7.8%) supraventricular tachycardia, 4 (3.5%) sinus tachycardia and 2 (1.7%) ventricular tachycardia with clinical symptom reproduction. There were 52 patients (45%) in the primary-ILR group and 63 (55%) in the post-CAT ILR group. Proportions of negative ILR monitoring (17/52 vs. 25/63; p = 0.56) and pacemaker implantations (7/52 vs. 15/63; p = 0.23) did not differ between groups. Baseline ECG conduction disorders predicted pacemaker implantation (n = 11/17; odds ratio:10.6; 95%CI: 3.15–35.3; p < 0.001). CAT was more often positive (73% vs. 40%; p < 0.001) in primary-ILR group. Conclusions: Primary ILR implantation was associated with more positive CAT compared with delayed ILR implantation, but negative monitoring and pacemaker implantations were not different between groups. ECG conduction disorders predicted subsequent pacemaker implantation.

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Section: Discussionmentioning

confidence: 99%

“…prognostic information with respect to future syncope recurrence, especially in the context of pacing therapy [ 8 ]…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Primary vs. Delayed Strategy of Implanting a Cardiac Monitor for Unexplained Syncope

Yasa

Intzilakis

Ricci

et al. 2022

JCM

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“…Permanent pacemaker plays an important role in the treatment of symptomatic bradyarrhythmia, Syncope can be induced by multiple factors. However, syncope triggered by cardiac causes often indicates poor prognosis and high mortality[ 2 ]. The causes of syncope in patients with permanent cardiac pacemakers are mostly neurogenic, hemodynamic instability caused by ventricular tachycardia, pacemaker sensing and pacing dysfunction due to abnormalities associated with pacemaker and lead.…”

Section: Discussionmentioning

confidence: 99%

Pacemaker electrode rupture causes recurrent syncope: A case report

Zhu¹,

Tang²,

Huang³

2022

World J Clin Cases

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BACKGROUND Currently, the implantation of permanent cardiac pacemakers entails mostly subclavian vein puncture, which is relatively simpler and easier to master. However, due to individual differences, some patients carry a narrow space between the clavicle and the first rib. If the range of activity of the upper limb is increased, the friction between the electrode wire and the bone gap leads to the breakage of the electrode wire, which is manifested by poor pacemaker perception and pacing. CASE SUMMARY A 68-year-old woman underwent permanent pacemaker implantation in our hospital because of third-degree atrioventricular block 6 years ago. At that time, the patient was recommended to have a dual-chamber permanent pacemaker implantation, and finally chose a single-chamber permanent pacemaker because she could not afford the cost. The patient has repeatedly lost consciousness for no obvious reason in the past 3 d, and went to our hospital for treatment. The chest X-ray showed that the pacemaker electrode was broken. After the patient was given a pacemaker electrode replacement, the patient did not continue to lose consciousness. CONCLUSION Because the electrodes implanted in the subclavian approach are close to the clavicle and the first rib, the pacemaker electrodes may wear out. If the patient loses consciousness again after the pacemaker is implanted, we should consider whether there is a pacemaker. The possibility of electrode breakage, and timely help the patient to replace the new pacemaker electrodes.

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“…Patients with hypotensive susceptibility may be at risk of syncope recurrences after pacing, due to persistence of vasodepression. Syncope recurs after pacing in ~15%-20% of patients, due to the coexistence of bradycardic and hypotensive phenotypes [54,77,79,80]. Specific treatment interventions against hypotensive susceptibility are necessary in addition to pacing to minimize recurrence risk.…”

Section: Cardiac Pacingmentioning

confidence: 99%