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Issue III registry defines best syncope candidates for cardiac pacing
Date:6/26/2013

gesting NMS 99 were found to be asystolic (where the heart stops beating for a short period of time) and 63 hypotensive (where blood pressure falls).

Altogether 52 patients received a pacemaker, of which 26 had a positive table tilt test result(TT+) and 26 patients a negative table tilt test (TT-)result. After 21 months the syncope recurrence rates were 55% (95% CI 29-85) in TT+ patients fitted with the pacemaker versus 5% ( 95%CI 1-32)in TT- patients fitted with the pace maker (p=0.004). When the recurrence rate of 55% in the TT+ patients was compared to 44 untreated patients (who acted as controls) who had recurrence rates of 64% the difference was not found to be statistically significant (p=0.75).

For patients with negative table tilt tests, the observed 5% recurrence rate was similar to that observed for patients paced for cardiac intrinsic bradycardia. "Thus, pacemaker therapy can be offered to these patients with the same confidence as it can in patients with sick sinus syndrome or AV block," said Prof. Brignole. "Such patients can be reassured that, after pacemaker implantation, they'll likely be free from reoccurrences of syncope."

But before pace maker therapy is offered to patients with TT+ even if they have experienced an asystolic response during the tilt test patience should be cautioned they may have reoccurances. "Although some benefits may still be possible in terms of reduced syncope burden, patients should be informed that they'll likely have some recurrences despite pacing," said Prof. Brignole.

Most of the misdiagnoses in the study were due to intrinsic cardiac arrhythmias which were largely unpredictable from baseline characteristics. "This aspect, which has not yet been clarified in the literature, may be relevant in clinical practice," he said, adding that it further justifies the usage of the ILR diagnostic tool.


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Contact: Jacqueline Partarrieu
press@escardio.org
33-622-418-492
European Society of Cardiology
Source:Eurekalert

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