Role of closed loop stimulation pacing (CLS) in vasovagal syncope

Ruzieh, Mohammed; Ammari, Zaid; Dasa, Osama; Karim, Saima; Grubb, Blair P.

doi:10.1111/pace.13194

Cited by 7 publications

(9 citation statements)

References 33 publications

(60 reference statements)

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“…These patients received dual‐chamber pacemaker using Biotronik CLS. CLS pacing has been reported to significantly reduce syncope burden and time to first recurrence and prolonging time to first syncope recurrence …”

Section: Discussionmentioning

confidence: 99%

“…CLS pacing has been reported to significantly reduce syncope burden and time to first recurrence and prolonging time to first syncope recurrence. 14,15 Although the syncope was completely eliminated in all patients who received dual-chamber pacemaker, most of the patients continued to have orthostatic tachycardia and dizziness. We evaluate all patients of POTS who present with unusually frequent and severe episodes of syncope with ILR.…”

Section: Discussionmentioning

confidence: 99%

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Role of implantable loop recorders in patients with postural orthostatic tachycardia syndrome

Kanjwal

Qadir

Ruzieh

et al. 2018

Pacing Clinical Electrophis

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Role of implantable loop recorders in patients with postural orthostatic tachycardia syndrome

Kanjwal

Qadir

Ruzieh

et al. 2018

Pacing Clinical Electrophis

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“…19,20 Likewise, to date, all 11 studies (observational: five retrospective and two prospective; RCT: three single-blind and one double-blind) assessing CLS in VVS have been positive. 21 Also, a previous clinical registry enrolling 706 patients followed during a median of 243 ± 101 days with CLS pacing (implanted due to atrial arrhythmia) has shown that CLS reprogramming was seldom undertaken (<10%) and its deactivation due to intolerance was very low (2.3%). 22 The ongoing multicenter Guidelines 24 ).…”

Section: Subgroup Analysesmentioning

confidence: 99%

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%

“…Recently, more studies have shown superior efficacy of CLS compared to conventional pacing. [13][14][15] 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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Role of closed loop stimulation pacing (CLS) in vasovagal syncope

Cited by 7 publications

References 33 publications

Role of implantable loop recorders in patients with postural orthostatic tachycardia syndrome

Role of implantable loop recorders in patients with postural orthostatic tachycardia syndrome

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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