Incidence and Predictors of Syncope in Paced Patients with Sick Sinus Syndrome

Abstract

(1) syncope in paced patients with SSS has multiple etiologies and may be multifactorial; (2) the only predictor of syncope after pacemaker implant is the occurrence of preimplant syncope as the main indication for pacing; (3) extensive Holter monitoring is not useful to document bradycardiac origin of syncope nor to predict its recurrence; (4) SSS probably overlaps with other entities such as autonomic dysfunction, vasovagal syncope, carotid sinus hypersensitivity, and venous pooling, which would provide an explanation for recurrent syncope in patients with normal pacemaker function.

Guidelines on management (diagnosis and treatment) of syncope

“…Thus, increased susceptibility to neurally-mediated bradycardia/hypotension, alone or in association with the intrinsic sinus-node dysfunction, is necessary to cause syncope. A reflex mechanism of syncope fits well with the unpredictable natural history of syncopal recurrences, and may in part explain why syncope recurs in about 20% of sick sinus syndrome patients during long-term follow-up despite adequate pacing [327] . In general, cardiac pacemaker therapy is indicated and has proved highly effective in patients with sinus node dysfunction when bradyarrhythmia has been demonstrated to account for syncope [328][329][330][331][332][333] (Class I, level B).…”

Syncope in Patients with Pacemakers

“…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 %.…”

“…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.…”

Si̇nüs Düğüm Fonksi̇yon Bozukluğu Ve Egzersi̇z Sonrasi Oluşan Vasovagal Senkop

“…Elektrokardiyografik takipte bradikardi ve asistoli ile birlikte senkop olan hastalarda, sinüs düğüm fonksiyon bozukluğu kendi anatomik bozukluğuna bağlı olarak ''intrensek'' ya da anormal vagal reflekslere bağlı olarak ''ekstrensek'' kökenli olabilir (10). Ayrıca, senkop geçiren hasta sinüs sendromlu bireylerde de, senkopa yol açan olayın vasovagal kökenli olabileceği ileri sürülmüştür (11,12 Vasovagal senkopun ortaya çıkarılmasında tilt testi altın standarttır (2). Ayakta durur pozisyonda alt ekstremitelere olan venöz göllenme nedeniyle kalbe gelen kan miktarı azalmakta, azalan ventrikül hacmini telafi etmek amacıyla daha güçlü kalp kasılması olmaktadır.…”