title: Is DDD superior to VVI pacing in mixed carotid sinus syndrome? An acute and medium-term study.
abstract: The aim of this study was to evaluate the importance of atrial synchronism for pacing therapy of patients with mixed carotid sinus syndrome. In 23 patients (21 m, two f; mean age 69 +/- 8 years) affected by symptomatic mixed carotid sinus syndrome we performed: (1) Research of ventriculo-atrial conduction, orthostatic hypotension and pacemaker effect; and (2) Carotid sinus massage in the standing position during VVI and DVI temporary pacing. Next, all patients received a permanent DDD pacemaker and entered a 2 month two period single-blind, randomized, cross-over study on DVI/DDD versus VVI mode. During the DVI/DDD period, no syncope occurred in any patients, minor symptoms persisted in 11 (48%) of them; during VVI period syncopes recurred in three patients, symptoms requiring the withdrawal of VVI pacing and premature DVI/DDD reprogramming in eight patients, minor symptoms in 17 (74%). A comparison between 14 patients, who preferred DVI/DDD period (Group A), and the remaining nine patients who noted no preference between DVI/DDD and VVI period (Group B) was performed on the basis of the preimplant evaluation. Group A patients had a greater pacemaker effect (-34 +/- 16 mmHg vs -16 +/- 14 mmHg) and a higher prevalence of symptomatic pacemaker effect (50% vs 0%), of ventriculo-atrial conduction (78% vs 44%) and of orthostatic hypotension (50% vs 11%), while the entity of the systolic pressure fall caused by carotid sinus massage was similar in the two groups either during VVI mode (Group A -51 +/- 16 mmHg vs Group B -56 +/- 27 mmHg) or DVI mode (Group A -38 +/- 17 mmHg vs Group B -45 +/- 17 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)
authors: Laboratory of Electrophysiology and Pacemaker Implant, Service of Cardiology, Hospital of Lavagna, Italy.
authors: M
authors: M
authors: Brignole
authors: B
authors: B
authors: Sartore
authors: M
authors: M
authors: Barra
authors: C
authors: C
authors: Menozzi
authors: G
authors: G
authors: Lolli
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002346:Carotid Sinus / Q000503:physiopathology*; D002986:Clinical Trials as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology; D008297:Male; D010138:Pacemaker, Artificial; D011897:Random Allocation; D012021:Reflex, Abnormal / Q000150:complications / Q000628:therapy*; D013575:Syncope / Q000209:etiology* / Q000628:therapy; D013577:Syndrome