title: Effect of dual-chamber pacing with automatic rate-drop sensing on recurrent neurally mediated syncope.
abstract: We tested the hypotheses that a dual-chamber pacemaker that paces when intrinsic rate drops abruptly would reduce the number of syncopal spells and improve the quality of life in patients with highly recurrent neurally mediated syncope. Twelve patients with highly frequent neurally mediated syncope and at least 1 syncopal spell after tilt testing received dual-chamber pacemakers with automatic rate-drop sensing. The pacemakers were implanted 17+/-26 months after tilt testing, and the patients then were followed for 12+/-2 months. We compared the time to the first recurrence of syncope, syncope frequency, and quality of life for the 2 periods between tilt testing and pacemaker implantation, and between implantation and last follow-up. Only 6 of 12 patients fainted after pacemaker insertion. The median time to syncope recurrence before and after pacing was 7 days and 5.3 months, respectively. The geometric mean frequency of faints before and after pacing was 5.0 spells/month (95% confidence interval 2.7 to 9.2) and 0.30 spells/month (95% confidence interval 0.2 to 0.4), p <0.001. After 6 months the mean perception of health on the 100-point EuroQol scale rose from 55 to 82 (p = 0.003), and the general health perception on the SF-36 scale rose from 51 to 72 (p = 0.005). Permanent dual-chamber pacing with automatic rate-drop sensing in patients with highly frequent syncope is associated with a marked reduction in the likelihood of syncope and a marked improvement in quality of life.
authors.affiliation: Cardiovascular Research Group, University of Calgary, Alberta, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Sheldon
authors.forename: M L
authors.initials: ML
authors.lastname: Koshman
authors.forename: W
authors.initials: W
authors.lastname: Wilson
authors.forename: T
authors.initials: T
authors.lastname: Kieser
authors.forename: S
authors.initials: S
authors.lastname: Rose
mesh_terms: D000293:Adolescent; D000328:Adult; D002304:Cardiac Pacing, Artificial; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D015203:Reproducibility of Results; D055502:Secondary Prevention; D019462:Syncope, Vasovagal / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D018667:Tilt-Table Test; D016896:Treatment Outcome