Syncope in paced patients with sick sinus syndrome from the DANPACE trial: incidence, predictors and prognostic implication

Chuen, Marie Jennyfer Ng Kam; Kirkfeldt, Rikke Esberg; Andersen, Henning; Nielsen, Jens Cosedis

doi:10.1136/heartjnl-2013-304976

Cited by 24 publications

(13 citation statements)

References 26 publications

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“…This was corroborated by Lopes et al in 2011, 32 using dominantly dual chamber pacing with 10.9% recurrence also in 5 years, but Brignole and Menozzi found 20% in their series over 5 years of follow-up 33 . Furthermore, in relation to current data, these figures are relatively acceptable with ∼20% in sinus node disease in 5.5 years 34 and 25% in 2 years in older vasovagal patients 35 . One randomized trial (RCT) was performed on 60 patients in 1992, with a highly significant benefit of pacing being shown ( p < 0.002), 36 with a second RCT by another group in 2007 serving to confirm the earlier results 37 …”

Section: Treatment Of Cardioinhibitory Csssupporting

confidence: 80%

Carotid sinus syndrome: Progress in understanding and management

Sutton

2014

Global Cardiology Science and Practice

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Carotid sinus syndrome (CSS) is a disease of the autonomic nervous system presenting with syncope, especially in older males who often have cardiovascular disease. The aetiology is unknown and epidemiological data is limited. Forty new patients/million population have been estimated to require pacing for CSS and these patients represent ∼9% of those presenting syncope to a specialist facility. CSS is defined as a response to carotid sinus massage (CSM) that includes reproduction of spontaneous symptoms. Cardioinhibitory CSS shows 3s asystole on CSM and vasodepressor CSS shows >50 mmHg fall in blood pressure (BP), there are mixed forms. The methodology of CSM requires correct massage in the supine and upright with continuous ECG and BP. Assessment of the vasodepressor component implies the ‘method of symptoms’ using atropine to prevent asystole. Carotid sinus hypersensitivity (CSH) is a related condition where CSM is positive in an asymptomatic patient. CSH cannot be assumed to respond to pacing. CSS patients present syncope with little or no warning. If no cause is revealed by the initial evaluation, CSM should be considered in all patients >40 years. CSM carries a small risk of thromboembolism. Therapy for cardioinhibitory CSS is dual chamber pacing, which is most effective in patients with a negative tilt test. Syncope recurrence is ∼20% in 5 years in paced patients. Therapy for the vasodepressor component of CSS, as pure vasodepression or mixed, where tilt testing will likely be positive, is often unrewarding: alternative therapeutic measures may be needed including discontinuation/reduction of hypotensive drugs.

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Section: Treatment Of Cardioinhibitory Csssupporting

confidence: 80%

Carotid sinus syndrome: Progress in understanding and management

Sutton

2014

Global Cardiology Science and Practice

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“…In the absence of the above situations, despite adequate pacing, syncope recurs in approximately 15-28% of patients at 5 years [339][340][341] (see Supplementary Data Table 9). This is due to the frequent association of a vasodepressor reflex mechanism with sinus node disease.…”

Section: Sinus Node Diseasementioning

confidence: 99%

2018 ESC Guidelines for the diagnosis and management of syncope

Parikka¹

2018

Revista Española de Cardiología (English Edition)

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“…Syncope or similar symptoms after implantation of pacemakers (or other cardiac implantable devices) is not as uncommon as is thought despite a clear cause and standard indication of pacing. The incidence may depend on the indication of implant - lowest when the indication was symptomatic atrioventricular block in structurally normal heart, highest when the indication was primarily vasovagal syncope and in between in patients with sick sinus syndrome where it may be seen in up to 17.5% of patients [2] , [3] , [4] , [5] .…”

Section: Is Syncope Seen In Patients With Pacemakers Despite Normal Pmentioning

confidence: 99%

“…The predictors of syncope in paced patients includes extremes of age (<40 years and >80 years) [2] , previous history of syncope [2] , [3] , past history of myocardial infarction or heart failure and presence of co-morbidities [2] . Among non-paced patients, vasovagal syncope is the most common cause of syncope in young patients whereas in elderly patients cardiac causes, drug induced and postural hypotension are the predominating causes [7] .…”

Section: Are There Identifiable Predictors Of Syncope In Paced Patienmentioning

confidence: 99%