Syncope in Patients with Cardiac Pacemakers

Abstract

Introduction It is challenging to diagnose syncope in patients with pacemakers. Because these patients have increased morbidity and mortality risks, they require immediate attention to determine the causes in order to provide appropriate treatment. This study aimed to investigate the causes and predictive factors of syncope as well as the methods used to diagnose syncope in cardiac pacemaker patients. Methods Patients with pacemakers implanted owing to sinus node disease or atrioventricular block were evaluated with standardized questionnaires, endocavitary electrograms, and other tests based on the suspected causes of syncope. Mann-Whitney U tests were used to analyze continuous variables and Chi-squared or Fisher’s exact tests were used for categorical variables. Logistic regression was used for multivariate analyses. Statistical significance was P <0.05. Results The study included 95 patients with pacemakers: 47 experienced syncope in the last 12 months and 48 did not. Of the 100 documented episodes of syncope, 48.9% were vasovagal syncopes, 17% had cardiac-related causes, 10.6% had unknown causes, and 8.5% had pacemaker failure. The multivariate analysis showed that a New York Heart Association (NYHA) Functional Class II was a significant factor for developing syncope ( P <0.01). Conclusion While the most common type of syncope in pacemaker patients was neurally mediated, it is important to perform detailed evaluations in this population as the causes of syncope can be life-threatening. The best diagnostic methods were stored electrogram analysis and the tilt table test. NYHA Functional Class II patients were found to have a higher risk for syncope.

Using Vibration for Secure Pairing with Implantable Medical Devices: Development and Usability Study (Preprint)

“…Furthermore, network connections with these devices can be ad-hoc. For instance, in an emergency (e.g., patients with cardiac implants can experience syncope symptoms and become unconscious [52]), a doctor may quickly have to use a new programmer device to connect to the patient's IMD. Due to these limitations of IMDs, conventional pairing techniques (such as the ones based on symmetric/public keys [1]) are often not a viable option [39,74].…”

Syncope: a narrative review of the scores and their applicability in the emergency room

“…Syncope is classified as the sudden and transient loss of consciousness associated with the loss of postural tone that presents rapid and spontaneous recovery, which does not cause permanent neurological damage (ROCHA EA, et al, 2021). Patients who report loss of consciousness require immediate attention to identify the cause and undergo risk stratification, which is essential to establish appropriate treatment (YASA E, et al, 2019).…”