Cardiac Pacing in Cardioinhibitory Reflex Syncope: Clinical Use of Closed-loop Stimulation

Abstract

Cardiac pacing has been studied extensively in patients with reflex syncope over the past two decades. The heterogeneity of the forms and clinical manifestations of reflex syncope explain the controversial results of older randomised clinical trials. New evidence from recent trials has changed medical practice, now leading to clear indications for pacing in patients with asystolic syncope documented during carotid sinus massage, implantable cardiac monitoring or tilt testing. Given that recent trials in reflex syncope have been performed using the closed-loop stimulation algorithm, the authors will briefly discuss this pacing mode, review hypotheses about the mechanisms underlying its activation during syncope and provide practical instructions for programming and troubleshooting.

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 ].…”

Vasovagal Syncope at Work: A Narrative Review for an Occupational Management Proposal

“…Dual chamber pacing is recommended in extremely selective reflex syncope patients who are older than 40 and have severe, repeated, unpredictable syncopal episodes with confirmed asystole caused by either CSM, tilt testing, or monitored using a monitoring system [ 22 , 23 ]. The design of closed-loop stimulation, one of the pacing algorithms that are now available, is expected to trigger pacing early and at a sufficient rate before a drop in blood pressure, as has been seen during the tilt test [ 24 , 25 , 26 , 27 ].…”