Permanent cardiac pacing in elderly patients with recurrent falls, dizziness and syncope, and a hypersensitive cardioinhibitory reflex

Abstract

SummaryThe study was designed to assess the outcome of treatment with permanent dual-chamber pacing of elderly patients with falls, dizziness and syncope associated with the demonstration of a hypersensitive cardioinhibitory reflex. Questionnaires were sent to patients (and their general practitioners) who had been referred to a regional pacing centre with recurrent falls, dizziness or syncope diagnosed as likely to be secondary to cardioinhibitory carotid sinus syndrome or predominantly cardioinhibitory vasovagal syndrome. After pacemaker insertion, 84% of patients had no further syncope over a mean follow-up period of 10 (range 1.5 to 30) months. Minor symptoms persisted in only 40% of all patients. Symptoms were unchanged in 22%. It was concluded that permanent dual-chamber pacing is an effective treatment for elderly patients with recurrent falls, dizziness and syncope in whom a hypersensitive cardioinhibitory reflex is found. Good results were obtained in this group with a simple diagnostic work-up.

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

“…12 Patients with cardiac sarcoidosis and conduction abnormalities have a worse prognosis than that of patients with idiopathic AV block. 286,287 Immunosuppression can result in transient reversal of AV block; however, the reversibility is unpredictable. [287][288][289] As such, it is recommended to proceed with pacing according to the most recent guidelines regardless of AV block reversibility.…”

Amnesia for Loss of Consciousness in Carotid Sinus Syndrome

“…Cardioinhibitory carotid sinus syndrome (CICSS) is traditionally associated with syncope, but has recently also been implicated in the genesis of falls in older patients (1)(2)(3). Both observational (2,3) and intervention (1) studies have demonstrated this causal role, but the reasons why patients present with falls rather than syncope are unclear.…”

Diagnosis of carotid sinus hypersensitivity in older adults: carotid sinus massage in the upright position is essential

“…3 Cardioinhibitory and mixed carotid sinus hypersensitivity subtypes are amenable to permanent pacing. The cardioinhibitory subtype is defined by the finding of at least three seconds of asystole during carotid sinus massage; if a fall in systolic blood pressure of more than 50 mm Hg is also present, this defines the mixed subtype 1-4.…”