Cardiac Pacing- New Hope For Reflex Syncope Patients
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The benefit of cardiac pacing in patients with severe recurrent reflex syncope and asystole induced by tilt testing has not been established. The usefulness of tilt-table test to select candidates for cardiac pacing is controversial.

Researchers randomly assigned patients aged 40 years or older who had at least two episodes of unpredictable severe reflex syncope during the last year and a tilt-induced syncope with an asystolic pause longer than 3s, to receive either an active (pacing ON; 63 patients) or an inactive (pacing OFF; 64 patients) dual-chamber pacemaker with closed loop stimulation (CLS). The primary endpoint was the time to first recurrence of syncope. Patients and independent outcome assessors were blinded to the assigned treatment.

After a median follow-up of 11.2 months, syncope occurred in significantly fewer patients in the pacing group than in the control group. The estimated syncope recurrence rate at 1 year was 19% (pacing) and 53% (control) and at 2 years, 22% (pacing) and 68% (control). A combined endpoint of syncope or presyncope occurred in significantly fewer patients in the pacing group. Minor device-related adverse events were reported in five patients (4%).

Conclusively, In patients aged 40 years or older, affected by severe recurrent reflex syncope and tilt-induced asystole, dual-chamber pacemaker with CLS is highly effective in reducing the recurrences of syncope. These findings support the inclusion of tilt testing as a useful method to select candidates for cardiac pacing.

Source: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaa936/6024826
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