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

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.

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

2015 ◽  
Vol 143 (1-2) ◽  
pp. 23-27
Author(s):  
Nikola Radovanovic ◽  
Bratislav Kircanski ◽  
Sinisa Pavlovic ◽  
Srdjan Raspopovic ◽  
Velibor Jovanovic ◽  
...  
Keyword(s):  
Mixed Type ◽  
Carotid Sinus ◽  
Pacemaker Implantation ◽  
Cardiac Pacing ◽  
Tilt Test ◽  
Carotid Sinus Syndrome ◽  
Pacemaker Therapy ◽  
Study Results ◽  
The Mean ◽  
Head Up Tilt Test

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.

Reflex syncope

ESC CardioMed ◽  
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.

scholarly journals The Current Indication for Pacemaker in Patients with Cardioinhibitory Vasovagal Syncope

2016 ◽  
Vol 10 (1) ◽  
pp. 179-187
Author(s):  
Rose Mary Ferreira Lisboa da Silva
Keyword(s):  
Vasovagal Syncope ◽  
Initial Step ◽  
Tilt Test ◽  
Physical Injury ◽  
Implantable Loop Recorder ◽  
Open Label ◽  
Loop Recorder ◽  
Double Blind ◽  
Injury Recurrence

The most frequent cause of syncope is vasovagal reflex. It is associated with worse quality of life, depression, fatigue and physical injury. Recurrence of vasovagal syncope is an aggravating, reaching the rate of 69%. Initial step and pharmacological treatment may not work, especially in patients with recurrent syncope without prodrome. These patients can present cardioinhibitory response with asystole. Studies were designed to analyses the effectiveness of pacemaker for prevention of syncope. In this review, nonrandomized clinical trials, open-label randomized, double-blind randomized, placebo-controlled, and studies based on tilt test or Implantable Loop Recorder findings will be discussed.

Young syncopal man and decision about permanent cardiac pacing

Open Medicine ◽  
2008 ◽  
Vol 3 (4) ◽  
pp. 505-509
Author(s):  
Malgorzata Lelonek ◽  
Adam Stanczyk ◽  
Jan Goch
Keyword(s):  
Electrophysiological Study ◽  
Cardiac Pacing ◽  
Tilt Test ◽  
Av Block ◽  
Implantable Loop Recorder ◽  
Loop Recorder ◽  
Junctional Rhythm

AbstractA 20-year old man experienced recurrent syncope, that suggested a partially neutrally-mediated mechanism, but in some cases were without a prodrome. The tilt test was negative. The 12-lead ECG and electrophysiological study showed first-degree AV block. Syncope in bradyarrhythmia was suspected and an implantable loop recorder was indicated. In the first month after implantation the patient experienced one syncopal episode. In the stored ECG, AV junctional rhythm was detected. The patient received a pacemaker and symptoms improved.

scholarly journals 656 Cough, a rare and not well recognized symptom of lead perforation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Francesca Parisi ◽  
Elisabetta Demurtas ◽  
Marta Allegra ◽  
Lorenzo Pistelli ◽  
Francesca Frecentese ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Right Ventricular ◽  
Rare Complication ◽  
Pacemaker Implantation ◽  
Productive Cough ◽  
Loop Recorder ◽  
Lead Perforation ◽  
Ventricular Lead ◽  
The Right ◽  
Contrast Ct

Abstract Aims Along with relevant progress in technology, pacemaker implantation is continuously improving its safety and efficacy in treating patients with bradyarrhythmias. Despite this, this procedure has several complications, including haematoma, pneumothorax, lead dislodgement, infection, lead perforation, and tamponade. Methods and results A 64-year-old woman underwent loop recorder implantation, after recurrent loss of consciousness, in order to assess arrhythmic causes of syncope. Two weeks later, an episode of paroxysmal complete AV block, conditioning a pause of 3 s, was recorded. Thus, the patient was scheduled for urgent dual-chamber pacemaker implantation. No complication apparently occurred during the procedure. An active fixation ventricular lead was positioned in right ventricular septal apex while passive fixation atrium lead in the right appendage. Soon after implantation the patient started to suffer by non-productive cough, clearly related to ventricular stimulation, either in DDD or in VVI pacing modality. During spontaneous ventricular activation (RBBB) no symptoms occurred. Transthoracic echocardiography, performed the day after implantation, revealed a small pericardial effusion (diastolic diameter < 10 mm) along the apical segments, near the tip of the right ventricular lead. Suspicion of right ventricular lead perforation arised. The patient underwent urgent contrast chest CT confirming pericardial effusion, and showing an intramyocardium placement of the right ventricular apical lead. No active bleeding in pericardium was observed. Due to persistence of symptoms, we decided to perform right ventricular lead repositioning in right middle septum, with pericardiocentesis back-up promptly available. Post-procedure, palpitation, and cough abruptly disappeared. After 3 months follow-up, no significant symptoms were reported and pericardial effusion gradually disappeared. Conclusions We describe a singular case of cough, as atypical symptom immediately after pacemaker implantation. Pericardial effusion and contrast-CT showing intra-myocardial position of the tip guided our suspicion to a possible right ventricular lead microperforation. Although right ventricular lead parameters were completely normal this findings didn’t exclude RV perforation. The lead perforation is known as a rare complication of device implantation. Typical symptoms of RV lead perforation are chest pain and hypotension. The patient described in our case showed a haemodynamically stable pericardial effusion accompanied by non-productive cough, clearly time-related to RV stimulation. In literature, there is only another similar case report. The cough is a rare and not well recognized symptom of lead perforation. Early diagnosis of RV perforation allows to perform urgently and safely (pericardiocentesis back-up) lead replacement/repositioning. Echocardiography and contrast-CT could be useful in order to assess a possible pericardial effusion or intramyocardial/pericardial position of RV lead tip.

Sign in / Sign up

Export Citation Format

Share Document