Prevention of Syncope Through Permanent Cardiac Pacing in Patients With Bifascicular Block and Syncope of Unexplained Origin

Abstract

Background— Syncope in patients with bifascicular block (BFB) is a common event whose causes might be difficult to assess. Methods and Results— Prevention of syncope through permanent cardiac pacing in patients with bifascicular block (PRESS) is a multicenter, prospective, randomized, single-blinded study designed to demonstrate a reduction in symptomatic events in patients with bifascicular block and syncope of undetermined origin implanted with permanent pacemaker. Device programming mode (NASPE/BPEG code) at DDD with a lower rate of 60 ppm is compared with backup pacing at DDI with a lower rate of 30 ppm. The end point consisted of (1) syncope, (2) symptomatic presyncopal episodes associated with a device intervention (ventricular pacing), and (3) symptomatic episodes associated with intermittent or permanent atrioventricular block (any degree). One hundred one patients were enrolled and randomized. Primary end point events at 2 years were observed in 23 patients, with a significant lower incidence in the study group (hazard ratio, 0.32; 95% confidence interval [CI], 0.10–0.96; P =0.042). Reduction of any symptoms, associated or not with device intervention, was superior in DDD60 compared with DDI30 (hazard ratio, 0.4; 95% confidence interval, 0.25–0.78; P =0.0053). Fourteen patients developed other rhythm diseases and met class I indication for pacing. The annual incidence of rhythm disease development was 7.4%. Conclusions— In patients with bifascicular block and syncope of undetermined origin, the use of a dual chamber pacemaker programmed to DDD60 led to a significant reduction of syncope or symptomatic events associated with a cardioinhibitory origin, compared with DDI30 programming. Symptoms associated with a new onset of rhythm disease were found in 15% of the population at 2 years.

Implantable loop recorders in patients with unexplained syncope: Clinical predictors of pacemaker implantation

“…The PRESS Study, a prospective multicenter study randomized 101 patients with bifascicular block (BFB) and unexplained syncope implanted with a dual chamber PM to either DDD pacing mode with a 60 ppm lower rate or DDI mode with 30 ppm lower rate [37].…”

2013 Esc Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy

“…В недавнем рандомизированном, слепом исследова-нии [32] 51 пациент с бифасцикулярной блокадой, подписанный на активную DDD электростимуляцию с частотой 60 импульсов в минуту, сравнивались с 49 пациентами с бифасцикулярной блокадой, подпи-санными на неактивную электростимуляцию (DDI 30 импульсов в минуту). Через 2 года синкопальные или пресинкопальные состояния рецидивировали у 45% пациентов в контрольной группе и у 25% пациентов в лечебной группе (относительный риск 0,43; P=0,005).…”

2013 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy

“…En un reciente estudio aleatorizado y a simple ciego 32 , se comparó a 51 pacientes con bloqueo bifascicular asignados a estimulación cardiaca DDD activa a 60 lpm y 49 pacientes con bloqueo bifascicular asignados a estimulación cardiaca inactiva (DDI a 30 lpm). En 2 años, el síncope o el presín-cope se repitieron en el 45% de los pacientes del grupo control frente al 25% de los pacientes del grupo de tratamiento (cociente de riesgos instantáneos = 0,43; p = 0,005).…”