title: Determining the optimal pacing intervention rate for vasovagal syncope.
abstract: BACKGROUND
  In this study, patients with rate hysteresis pacemakers implanted for vasovagal syncope were re-studied using serial tilt testing to determine whether, once triggered, pacing was more effective if the intervention rate was higher than the standard rate.
  
  
  RESULTS
  Twenty patients (mean age 55.4 years, range 23-81, 14 male) were studied, with randomisation to either initial standard rate (80-90 beats/min) intervention, or to initial high rate (120 beats/min) intervention. Although 18 of the 20 reported complete abolition of syncope since pacing, only 8 patients could be objectively assessed. The respective mean time to tilt down after symptom onset with standard and high rate intervention was 193+/-234s and 185+/-143s, (P>0.05).
  
  
  CONCLUSIONS
  Repeat tilt testing was only of limited value in assessing the benefit of pacing. There was no advantage with high rate intervention in delaying the loss of consciousness (or intolerable symptoms) after the initial onset of symptoms.
authors.affiliation: Department of Cardiology, London Chest Hospital, London, UK. a_kurbaan@hotmail.com
authors.forename: A S
authors.initials: AS
authors.lastname: Kurbaan
authors.forename: A C
authors.initials: AC
authors.lastname: Franzén
authors.forename: Z
authors.initials: Z
authors.lastname: Stack
authors.forename: D
authors.initials: D
authors.lastname: Heaven
authors.forename: G
authors.initials: G
authors.lastname: Mathur
authors.forename: R
authors.initials: R
authors.lastname: Sutton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D012016:Reference Values; D012680:Sensitivity and Specificity; D019462:Syncope, Vasovagal / Q000175:diagnosis / Q000628:therapy*; D018667:Tilt-Table Test; D016896:Treatment Outcome