The role of cardiac pacing therapy in the management of carotid sinus syndrome

Introduction. Carotid sinus syndrome is characterized by a hypersensitive carotid sinus and syncope. Although we have clear guidelines for the diagnosis and treatment of carotid sinus syndrome, the efficacy of pacing therapy with this indication has not been the subject of many studies. Objective. This study aimed to assess the efficacy and safety of pacing therapy in the treatment of patients with carotid sinus syndrome and to determine the factors contributing to symptoms recurrence after pacemaker implantation. Methods. This study was retrospective and included 32 patients in whom a pacemaker was implanted due to carotid sinus syndrome at the Pacemaker Center, Clinical Center of Serbia, between April 2005 and April 2012. Carotid sinus massage and head-up tilt test (HUTT) were performed to select patients with cardioinhibitory and mixed type carotid sinus syndrome, who were enrolled to the study. Results. The mean age of patients was 65.6?11.5 years and 20 (62.5%) were men. The mean follow-up period was 4.3?1.9 years. HUTT was performed in 3 (9.4%) patients. Twenty-seven (84.4%) patients presented with cardioinhibitory and 5 (15.6%) with mixed type of carotid sinus syndrome. After pacemaker implantation, 22 (68.7%) patients had no further symptoms, 8 (25.0%) had syncope and 2 (6.3%) presyncope. The mixed type of the disease (HR 3.1; 95% CI 1.4-5.1; p=0.021) and implantation of pacemaker in VVI mode (HR 1.8; 95%CI 1.1-3.2; p=0.034) were independent predictors of symptoms recurrence. There were 3 (9.4%) perioperative surgical complications. Conclusion. Pacemaker therapy is an effective and safe treatment for patients with carotid sinus syndrome. As predictors of symptoms persistence after pacemaker implantation in our population, we identified the implantation of pacemaker in VVI mode and the mixed type of carotid sinus syndrome.

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Is pacemaker therapy the right key to patients with vasovagal syncope?

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1612597r ◽

2016 ◽

Vol 144 (11-12) ◽

pp. 597-601

Author(s):

Nikola Radovanovic ◽

Bratislav Kircanski ◽

Srdjan Raspopovic ◽

Sinisa Pavlovic ◽

Velibor Jovanovic ◽

...

Keyword(s):

Mixed Type ◽

Vasovagal Syncope ◽

Multiple Logistic Regression Analysis ◽

Pacemaker Implantation ◽

Cardiac Pacing ◽

Tilt Test ◽

Loop Recorder ◽

Pacemaker Therapy ◽

Study Results ◽

The Right

Introduction. Vasovagal syncope is the most common type of reflex syncope. Efficacy of cardiac pacing in this indication has not been the subject of many studies and pacemaker therapy in patients with vasovagal syncope is still controversial. Objective. This study aimed to assess the efficacy and safety of pacing therapy in treatment of patients with vasovagal syncope, to determine contribution of new therapeutic models in increasing its success, and to identify risk factors associated with a higher rate of symptoms after pacemaker implantation. Methods. A retrospective study included 30 patients with pacemaker implanted due to vasovagal syncope in the Pacemaker Center, Clinical Center of Serbia, between November 2003 and June 2014. Head-up tilt test was performed to diagnose vasovagal syncope. Patients with cardioinhibitory and mixed type of disease were enrolled in the study. Results. Mean age was 48.1 ? 11.1 years and 18 (60%) patients were men. Mean follow-up period was 5.9 ? 3.0 years. Primarily, implantable loop recorder was implanted in 10 (33.3%) patients. Twenty (66.7%) patients presented cardioinhibitory and 10 (33.3%) mixed type of vasovagal syncope. After pacemaker implantation, 11 (36.7%) patients had syncope. In multiple logistic regression analysis we showed that syncope is statistically more likely to occur after pacemaker implantation in patients with mixed type of vasovagal syncope (p = 0.018). There were two (6.7%) perioperative surgical complications. Conclusion. Pacemaker therapy is a safe treatment for patients with vasovagal syncope, whose efficacy can be improved by strict selection of patients. We showed that symptoms occur statistically more often in patients with mixed type of disease after pacemaker implantation.

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Reflex syncope

ESC CardioMed ◽

10.1093/med/9780198784906.003.0470 ◽

2018 ◽

pp. 2024-2028

Author(s):

Jean-Claude Deharo

Keyword(s):

Carotid Sinus ◽

Vasovagal Syncope ◽

Cardiac Pacing ◽

Tilt Test ◽

Specific Situation ◽

Diagnostic Strategy ◽

Reflex Syncope ◽

Specific Subgroup ◽

Recent Developments ◽

Head Up Tilt Test

Reflex syncope, also called neurally mediated syncope, accounts for 56–73% of the aetiologies of syncope, with a balanced incidence over the various age categories. The most common form is ‘vasovagal syncope’ where the trigger is pain, fever, instrumentation, emotion, or orthostatic stress; ‘situational syncope’ refers to syncope triggered by a specific situation, that is, micturition, defecation, swallowing, cough; and ‘carotid sinus syncope’, which may be triggered by carotid sinus manipulation or diagnosed in patients with syncope and positive carotid sinus massage. The term ‘atypical reflex syncope’ is used to describe reflex syncope occurring without an apparent trigger: the diagnosis is mainly based on history, exclusion of other causes of syncope, and a positive head-up tilt test. Although recent developments have prompted new pathophysiological hypotheses, including the adenosine pathway, the diagnostic strategy for reflex syncope remains mainly based on clinical evaluation and very few ancillary diagnostic tests. The pharmacological armament is still very limited while new perspectives have been opened for specific subgroup of patients. Regarding the very rare patients who are candidates for permanent cardiac pacing, a new pragmatic approach may help their selection and the prediction of the effect of pacing.

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