title: Prevention of syncope through permanent cardiac pacing in patients with bifascicular block and syncope of unexplained origin: the PRESS study.
abstract: BACKGROUND
  Syncope in patients with bifascicular block (BFB) is a common event whose causes might be difficult to assess.
  
  
  RESULTS
  Prevention of syncope through permanent cardiac pacing in patients with bifascicular block (PRESS) is a multicenter, prospective, randomized, single-blinded study designed to demonstrate a reduction in symptomatic events in patients with bifascicular block and syncope of undetermined origin implanted with permanent pacemaker. Device programming mode (NASPE/BPEG code) at DDD with a lower rate of 60 ppm is compared with backup pacing at DDI with a lower rate of 30 ppm. The end point consisted of (1) syncope, (2) symptomatic presyncopal episodes associated with a device intervention (ventricular pacing), and (3) symptomatic episodes associated with intermittent or permanent atrioventricular block (any degree). One hundred one patients were enrolled and randomized. Primary end point events at 2 years were observed in 23 patients, with a significant lower incidence in the study group (hazard ratio, 0.32; 95% confidence interval [CI], 0.10-0.96; P=0.042). Reduction of any symptoms, associated or not with device intervention, was superior in DDD60 compared with DDI30 (hazard ratio, 0.4; 95% confidence interval, 0.25-0.78; P=0.0053). Fourteen patients developed other rhythm diseases and met class I indication for pacing. The annual incidence of rhythm disease development was 7.4%.
  
  
  CONCLUSIONS
  In patients with bifascicular block and syncope of undetermined origin, the use of a dual chamber pacemaker programmed to DDD60 led to a significant reduction of syncope or symptomatic events associated with a cardioinhibitory origin, compared with DDI30 programming. Symptoms associated with a new onset of rhythm disease were found in 15% of the population at 2 years.
authors: Azienda Ospedaliera S. Filippo Neri, Roma, Italy. m.santini@rmnet.it
authors: Massimo
authors: M
authors: Santini
authors: Antonio
authors: A
authors: Castro
authors: Franco
authors: F
authors: Giada
authors: Renato
authors: R
authors: Ricci
authors: Giuseppe
authors: G
authors: Inama
authors: Germano
authors: G
authors: Gaggioli
authors: Leonardo
authors: L
authors: Calò
authors: Serafino
authors: S
authors: Orazi
authors: Miguel
authors: M
authors: Viscusi
authors: Leandro
authors: L
authors: Chiodi
authors: Angelo
authors: A
authors: Bartoletti
authors: Giovanni
authors: G
authors: Foglia-Manzillo
authors: Fabrizio
authors: F
authors: Ammirati
authors: Maria L
authors: ML
authors: Loricchio
authors: Claudio
authors: C
authors: Pedrinazzi
authors: Federico
authors: F
authors: Turreni
authors: Gianni
authors: G
authors: Gasparini
authors: Francesco
authors: F
authors: Accardi
authors: Giovanni
authors: G
authors: Raciti
authors: Antonio
authors: A
authors: Raviele
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004867:Equipment Design; D005260:Female; D006327:Heart Block / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D010138:Pacemaker, Artificial; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016037:Single-Blind Method; D013575:Syncope / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome