title: Long-term follow-up of DDDR closed-loop cardiac pacing for the prevention of recurrent vasovagal syncope.
abstract: OBJECTIVE
  Vasovagal syncope (VVS) is a common disorder characterized by a drop in blood pressure accompanied with bradycardia; although it is generally considered a benign condition, some patients may be highly symptomatic despite general counselling and/or pharmacological therapy. Closed-loop stimulation (CLS), responding to myocardial contraction dynamics, demonstrated effectiveness in short-term prevention of recurrent VVS. The aim of this study was to evaluate CLS pacing in a long-term follow-up.
  
  
  METHODS
  The study involved 35 patients (mean age 59 ± 15 years) with 3 years' follow-up (mean 61 ± 35 months). We compared syncopal events and presyncopes before and after CLS implantation. Mean number of syncopes for patients was six (range 1-24; 212 syncopal spells registered) before pacemaker implantation.
  
  
  RESULTS
  At follow-up, 29 of 35 patients (83%) were asymptomatic; one patient experienced recurrent loss of consciousness but reported an improvement in the quality of life (one syncope or presyncope per month after CLS, vs. one syncope per week and daily presyncopes before CLS). Five patients experienced syncopal recurrences after CLS (range: 1-7, with a total of 15 episodes); in all the cases, the number of post-CLS syncopes was significantly lower.
  
  
  CONCLUSIONS
  Our study seems to confirm previous results of short-term trials: DDDR-CLS pacing is an extremely useful tool in the prevention of recurring VVS, even in long-term follow-up.
authors.affiliation: Division of Cardiology, Univeristy of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy. miriam.bortnik@libero.it
authors.forename: Miriam
authors.initials: M
authors.lastname: Bortnik
authors.forename: Eraldo
authors.initials: E
authors.lastname: Occhetta
authors.forename: Gabriele
authors.initials: G
authors.lastname: Dell'Era
authors.forename: Gioel G
authors.initials: GG
authors.lastname: Secco
authors.forename: Anna
authors.initials: A
authors.lastname: Degiovanni
authors.forename: Laura
authors.initials: L
authors.lastname: Plebani
authors.forename: Paolo
authors.initials: P
authors.lastname: Marino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D011788:Quality of Life; D055502:Secondary Prevention; D019462:Syncope, Vasovagal / Q000503:physiopathology / Q000517:prevention & control* / Q000523:psychology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult