title: Permanent pacemaker implantation in octogenarians with unexplained syncope and positive electrophysiologic testing.
abstract: Syncope is a common problem in the elderly, and a permanent pacemaker is a therapeutic option when a bradycardic etiology is revealed. However, the benefit of pacing when no association of symptoms to bradycardia has been shown is not clear, especially in the elderly.
  
  
  
  The aim of this study was to evaluate the effect of pacing on syncope-free mortality in patients aged 80 years or older with unexplained syncope and "positive" invasive electrophysiologic testing (EPT).
  
  
  
  This was an observational study. A positive EPT for the purposes of this study was defined by at least 1 of the following: a corrected sinus node recovery time of >525 ms, a basic HV interval of >55 ms, detection of infra-Hisian block, or appearance of second-degree atrioventricular block on atrial decremental pacing at a paced cycle length of >400 ms.
  
  
  
  Among the 2435 screened patients, 228 eligible patients were identified, 145 of whom were implanted with a pacemaker. Kaplan-Meier analysis determined that time to event (syncope or death) was 50.1 months (95% confidence interval 45.4-54.8 months) with a pacemaker vs 37.8 months (95% confidence interval 31.3-44.4 months) without a pacemaker (log-rank test, P = .001). The 4-year time-dependent estimate of the rate of syncope was 12% vs 44% (P < .001) and that of any-cause death was 41% vs 56% (P = .023), respectively. The multivariable odds ratio was 0.25 (95% confidence interval 0.15-0.40) after adjustment for potential confounders.
  
  
  
  In patients with unexplained syncope and signs of sinus node dysfunction or impaired atrioventricular conduction on invasive EPT, pacemaker implantation was independently associated with longer syncope-free survival. Significant differences were also shown in the individual components of the primary outcome measure (syncope and death from any cause).
authors.affiliation: Cardiology Department, Athens General Hospital "G. Gennimatas," Athens, Greece; 2nd Department of Cardiology, National and Kapodistrean University of Athens Medical School, Attikon University Hospital, Athens, Greece. Electronic address: ggiann@med.uoa.gr.
authors.forename: Georgios
authors.initials: G
authors.lastname: Giannopoulos
authors.affiliation: Cardiology Department, Athens General Hospital "G. Gennimatas," Athens, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Kossyvakis
authors.affiliation: 2nd Department of Cardiology, National and Kapodistrean University of Athens Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Panagopoulou
authors.affiliation: Athens Heart Center, Athens Medical Center, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsiachris
authors.affiliation: Cardiology Department, Athens General Hospital "G. Gennimatas," Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Doudoumis
authors.affiliation: Cardiology Department, Athens General Hospital "G. Gennimatas," Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Mavri
authors.affiliation: Cardiology Department, Athens General Hospital "G. Gennimatas," Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Vrachatis
authors.affiliation: 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Letsas
authors.affiliation: 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece.
authors.forename: Michael
authors.initials: M
authors.lastname: Efremidis
authors.affiliation: 1st Department of Cardiology, Hellenic Red Cross Hospital, Athens, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Katsivas
authors.affiliation: 2nd Department of Cardiology, National and Kapodistrean University of Athens Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Lekakis
authors.affiliation: 2nd Department of Cardiology, National and Kapodistrean University of Athens Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Deftereos
mesh_terms: D000369:Aged, 80 and over; D001919:Bradycardia / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D022062:Electrophysiologic Techniques, Cardiac; D006327:Heart Block / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D010138:Pacemaker, Artificial; D013575:Syncope / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*
keywords: EPS; Electrophysiologic; Electrophysiologic study; Mortality; Pacing