Clinical context and outcome of carotid sinus syndrome diagnosed by means of the 'method of symptoms'

Solari, Diana; Maggi, Roberto; Oddone, Daniele; Solano, Alberto; Croci, Francesco; Donateo, Paolo; Brignole, Michele

doi:10.1093/europace/eut283

Cited by 41 publications

(25 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the study of Gaggioli et al, 21 patients with carotid sinus syndrome and TT+ had a 2.7-fold increased risk of syncopal recurrence compared with carotid sinus syndrome and TT-: at a mean follow-up of 33 months, syncope recurred in 21% of 70 patients versus 9% of 99 patients (P=0.02); positive TT was the only independent predictor of syncopal recurrence. Solari et al, 22 in 141 patients affected by carotid sinus syndrome, found that a mixed or vasodepressor response to TT was the only independent predictor of syncopal recurrence (hazards ratio, 1.8; P=0.01). In conclusion, in the light of the present study and of the above literature, it is clear that cardiac pacing is effective when TT is negative, whereas syncope can frequently recur when TT is positive.…”

Section: Discussionmentioning

confidence: 99%

Benefit of Pacemaker Therapy in Patients With Presumed Neurally Mediated Syncope and Documented Asystole Is Greater When Tilt Test Is Negative

Brignole

Donateo

Tomaino

et al. 2014

Circ: Arrhythmia and Electrophysiology

119

View full text Add to dashboard Cite

Background— In the Third International Study on Syncope of Uncertain Etiology (ISSUE-3), cardiac pacing was effective in reducing recurrence of syncope in patients with presumed neurally mediated syncope (NMS) and documented asystole but syncope still recurred in 25% of them at 2 years. We have investigated the role of tilt testing (TT) in predicting recurrences. Methods and Results— In 136 patients enrolled in the ISSUE-3, TT was positive in 76 and negative in 60. An asystolic response predicted a similar asystolic form during implantable loop recorder monitoring, with a positive predictive value of 86%. The corresponding values were 48% in patients with non–asystolic TT and 58% in patients with negative TT ( P =0.001 versus asystolic TT). Fifty-two patients (26 TT+ and 26 TT–) with asystolic neurally mediated syncope received a pacemaker. Syncope recurred in 8 TT+ and in 1 TT– patients. At 21 months, the estimated product-limit syncope recurrence rates were 55% and 5%, respectively ( P =0.004). The TT+ recurrence rate was similar to that seen in 45 untreated patients (control group), which was 64% ( P =0.75). The recurrence rate was similar between 14 patients with asystolic and 12 with non–asystolic responses during TT ( P =0.53). Conclusions— Cardiac pacing was effective in neurally mediated syncope patients with documented asystolic episodes in whom TT was negative; conversely, there was insufficient evidence of efficacy from this data set in patients with a positive TT even when spontaneous asystole was documented. Present observations are unexpected and need to be confirmed by other studies. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01463358.

show abstract

Section: Discussionmentioning

confidence: 99%

Benefit of Pacemaker Therapy in Patients With Presumed Neurally Mediated Syncope and Documented Asystole Is Greater When Tilt Test Is Negative

Brignole

Donateo

Tomaino

et al. 2014

Circ: Arrhythmia and Electrophysiology

119

View full text Add to dashboard Cite

show abstract

“…12 These data have been further supported by a later report from the same group, with more patients showing very similar findings. 13 The Italian SUP-2 study, including 10 Italian centres, recently reported a decision algorithm for older patients presenting clinically likely reflex syncope.…”

Section: Where We Are Nowmentioning

confidence: 99%

Syncope in Patients with Pacemakers

Sutton

2015

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

Syncope in a patient with a pacemaker commands urgent action to ascertain its cause and provide appropriate treatment. This is a well accepted statement but the field has evolved in recent years and, strangely, has received little attention.Many considerations bear on this issue. First, syncope in pacemaker patients is not common but may be more so than generally considered.The lack of frequency may be attributed to better technology and greater expertise amongst practitioners but it should be modulated by the fact that more patients today receive pacemakers for other indications than syncope, rendering them unlikely to sustain syncope even if their pacemaker system fails. Second, we now live in an era of telemedicine where remote monitoring not only provides an opportunity to identify technological or arrhythmic causes of syncope in a pacemaker patient but also a chance for the patient very readily to report such an episode to hospital carers.1 Third, more patients today receive pacemakers for reflex syncope where the device is not expected to achieve the results in syncope prevention that pertain in atrioventricular block (AVB).2,3 Included with this aspect of syncope in pacemaker patients must also now be the realisation that syncope may be reflex in the largest group of patients worldwide that receive pacemakers, those with sino-atrial node disease. 4 It is in these contexts that a review of this serious clinical problem is due. Where We WereIn the late 1980s and early 1990s, we had already achieved a high standard of implant techniques and devices were well constructed with rare failure. and an additional patient with sensing failure, which was unlikely to have been the cause of syncope.3 Thus, 4.3 % had pacing failure as the cause of syncope, while at the same time 8.6 % had orthostatic hypotension and 36.9 % were tilt positive. These tilt findings were invoked as explaining the syncope sustained by these patients but no explanation was found in another 30.4 %. They concluded that reflex syncope may be the most common cause of recurrent syncope in paced patients, with pacing hardware failure being quite rare. This theme was reiterated by Sgarbossa et al. in a large series of 507 sick sinus syndrome patients from the Cleveland Clinic. 4 In 62 ± 38 months of follow-up, they found syncope recurrence in 3 % at 1 year, 8 % at 5 years and 13 % predicted at 10 years. Their analysis of the causes of syncope indicated lead or pacemaker failure in 6.5 %, vasovagal in 18 %, orthostatic hypotension in 25.5 %, unexplained in 29.5 %, atrial tachyarrhythmias in 11.5 % and ventricular tachyarrhythmias in 5 %. They concluded that autonomic disturbances were the main contributors to syncope recurrence and pacing hardware failure was uncommon. Such conclusion was reached at a time when syncope in sick sinus syndrome was considered to be sinus arrest without effective escape mechanism rather than reflex in origin. However, Sgarbossa et al. noted that syncope prior to implant was the only reliable predictor of syncope post-imp...

show abstract

“…In a randomised controlled trial of withdrawal of psychotropic medications in 93 patients, Campbell et al 8 found a significant reduction in the risk of falling during 44 weeks of follow-up (1.16 vs 0.52 falls per person per year). In an acute randomised trial9 conducted on 32 patients affected by carotid sinus syncope, withdrawal of vasodilator therapy reduced the magnitude of the vasodepressor reflex induced by carotid sinus massage. This finding was confirmed by a recent observational study,10 which demonstrated that reducing/suspending vasoactive therapy in 96 patients affected by carotid sinus syndrome led to a reduction in the burden of syncope from a median of 0.5 syncopes per patient per year to a median 0 syncope per patient per year.…”

Section: Discussionmentioning

confidence: 99%