Dual-Chamber Pacing With Closed Loop Stimulation in Recurrent Reflex Vasovagal Syncope

Barón-Esquivias, Gonzalo; Morillo, Carlos A.; Moya-Mitjans, Àngel; Martı́nez-Alday, Jesús; Ruiz‐Granell, Ricardo; Lacunza, Javier; García‐Civera, Roberto; Gutiérrez‐Carretero, Encarnación; Romero-Garrido, Rafael

doi:10.1016/j.jacc.2017.08.026

Cited by 108 publications

(67 citation statements)

References 18 publications

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“…Mostly, drug‐based or change‐of‐lifestyle‐options are effectively preventing syncope. The use of cardiac pacemakers (PM) remains a controversial topic and should only be considered in very severe cases . This is reflected by a class IIb indication in current adult as well as pediatric guidelines .…”

Section: Introductionmentioning

confidence: 99%

Cardiac pacing in cardioinhibitory syncope in children

Paech

Wagner

Mensch

et al. 2018

Congenital Heart Disease

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Introduction Reflex vasovagal—or cardioinhibitory syncope is known to be a major cause of recurrent syncope in children. The mechanism of vasovagal syncope (VVS) is an interaction between a vagally mediated bradycardia or asystole and a more or less manifest vasodilatory component. Although pacing is not advisable as a standard approach in patients with VVS, it remains a treatment option of last resort in exceptionally severe cases, or patients with contraindication or refractoriness to drug therapy and life style changes. To effectively avoid VVS in these patients, the pacemaker has to both prevent bradycardia and to compensate for the vasodilatory component. Therefore, this study aimed to evaluate a simple pacemaker setting (VVI pacing with hysteresis) with the potential to prevent VVS in affected children. Methods Clinical data of patients, who were presented to the Department for Pediatric Cardiology, Heart Center Leipzig, in the period of 2001‐2017 for cardiac pacemaker implantation for cardioinhibitory syncope or pallid breath‐holding spells, were collected retrospectively. Results Eleven pediatric patients, median age 2.7 (0.8‐17) years, were included. Pacemaker settings are depicted. In 10 out of 11 patients, an entire abolishment of syncope could be achieved (P = .002). Conclusion The presented VVI pacing with hysteresis seems to be a promising pacemaker setting in pediatric patients with cardioinhibitory syncope who need a pacemaker. Unnecessary ventricular stimulation is effectively avoided, while cardiac output is preserved during cardioinhibition, by providing a sufficient paced heart rate, compensating for the often present vasodilatory component.

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Section: Introductionmentioning

confidence: 99%

Cardiac pacing in cardioinhibitory syncope in children

Paech

Wagner

Mensch

et al. 2018

Congenital Heart Disease

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“…When pooling data from all the trials, a 63% reduction in syncope recurrence was found (RR: 0.37; 95% CI: 0.14‐0.98; I 2 = 67%) (Figure ). Subgroup analysis (Figure ) by follow‐up was not associated with a statistically significant subgroup effect ( P = .14) [>12 months (RR: 0.62; 95% CI: 0.22‐1.71, I 2 = 61%); ≤12months (RR: 0.14; 95% CI: 0.02‐0.77, I 2 = 38%)]. A subgroup effect ( P = 0.07) was found when analysing blinding.…”

Section: Resultsmentioning

confidence: 95%

“…Number of participants varied from 26 to 100 patients. Follow‐up was as short as 11 months to a maximum of 24 months . All studies enrolled patients with cardioinhibitory syncope detected through TTT except one, which used ILR .…”

Section: Resultsmentioning

confidence: 99%

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A systematic review on recurrent cardioinhibitory vasovagal syncope: Does pacing therapy break the fall?

Cunha

Rocha

Gomes

et al. 2019

Pacing Clinical Electrophis

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Vasovagal reflex is the most common cause of syncope. Pacemaker with rate drop response (RDR) or closed‐loop stimulation (CLS) anti‐syncope algorithms have been studied in recurrent vasovagal syncope (VVS), with conflicting results. We aim to investigate the role of pacemaker therapy and anti‐syncope pacing mode in cardioinhibitory recurrent VVS. MEDLINE, Cochrane Library and registered clinical trials were searched for single or double‐blind randomized controlled trials on pacing as a treatment for recurrent VVS. Five studies were eligible, overall enrolling 228 patients. After pooling data from all trials, pacemaker therapy showed a 63% reduction in syncope recurrence compared to control [Risk Ratio (RR): 0.37; 95% CI: 0.14‐0.98; I2 = 67%)]. Subgroup analyses suggested that the effect was greater in single‐blind studies (RR: 0.07; 95% CI: 0.01‐0.52, I2 = 0%). When comparing pacing algorithms, the results from RDR versus no pacing trials (n = 2) did not show a significant reduction in syncope recurrence (RR: 0.73; 95% CI: 0.25‐2.16, I2 60 = 75%). In contrast, the data from the CLS versus standard pacing trials (n = 3) evidenced a statistically meaningful reduction in syncopal burden (RR: 0.18; 95% CI: 0.07‐0.47, I2 = 0%). It is unclear whether pacemaker therapy reduces syncopal burden in cardioinhibitory recurrent VVS. However, our results suggest effectiveness of CLS pacing mode.

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“…However, the previous studies have small sample sizes with no more than 50 subjects included. Recently, more studies have shown superior efficacy of CLS compared to conventional pacing . In this systematic review and meta‐analysis, we investigated the impact of CLS implantation on reduction in recurrent VVS events.…”

Section: Introductionmentioning

confidence: 99%

Closed‐looped stimulation cardiac pacing for recurrent vasovagal syncope: A systematic review and meta‐analysis

Rattanawong

Riangwiwat

Chongsathidkiet

et al. 2018

Journal of Arrhythmia

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BackgroundVasovagal syncope (VVS) is defined by transient loss of consciousness with spontaneous rapid recovery. Recently, a closed‐loop stimulation pacing system (CLS) has shown superior effectiveness to conventional pacing in refractory VVS. However, systematic review and meta‐analysis has not been performed. We assessed the impact of CLS implantation and reduction in recurrent VVS events by a systematic review and a meta‐analysis.MethodsWe comprehensively searched the databases of MEDLINE and EMBASE from inception to September 2017. Included studies were published prospective or retrospective cohort, randomized controlled trial, and case–control studies that compared VVS events between recurrent, severe, or refractory cardioinhibitory VVS patient implanted with CLS and conventional pacing. Data from each study were combined using the random‐effects, generic inverse variance method of DerSimonian and Laird to calculate odds ratios and 95% confidence intervals.ResultsSix studies from November 2004 to October 2017 were included in this meta‐analysis involving 224 recurrent, severe, or refractory cardioinhibitory VVS patients implanted with CLS and 163 recurrent, severe, or refractory VVS patients implanted with conventional pacing. CLS significantly reduced recurrent VVS events compared to conventional pacing (pooled odds ratio = 0.23, 95% confidence interval: 0.13‐0.39, P = 0.000, I 2 = 36.5%) as well as subgroup of four randomized controlled trial studies (pooled odds ratio = 0.28, 95% confidence interval: 0.17‐0.44, P = 0.000, I 2 = 39.2%).ConclusionClosed‐loop stimulation significantly reduced recurrent VVS events up to 80% when compared to conventional pacing. Our study suggests that CLS is an effective tool for preventing syncope recurrences in patients with recurrent, severe, or refractory cardioinhibitory VVS.

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Dual-Chamber Pacing With Closed Loop Stimulation in Recurrent Reflex Vasovagal Syncope

Cited by 108 publications

References 18 publications

Cardiac pacing in cardioinhibitory syncope in children

Cardiac pacing in cardioinhibitory syncope in children

A systematic review on recurrent cardioinhibitory vasovagal syncope: Does pacing therapy break the fall?

Closed‐looped stimulation cardiac pacing for recurrent vasovagal syncope: A systematic review and meta‐analysis

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