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. 2020 Nov 22;37(1):189-195.
doi: 10.1002/joa3.12460. eCollection 2021 Feb.

Permanent pacemaker implantation in unexplained syncope patients with borderline sinus bradycardia and electrophysiology study-proven sinus node disease

Ioannis Doundoulakis  1 , Konstantinos A Gatzoulis  1 , Petros Arsenos  1 , Polychronis Dilaveris  1 , Ioannis Skiadas  1 , Dimitrios Tsiachris  2 , Christos-Konstantinos Antoniou  1 , Stergios Soulaidopoulos  1 , George Karystinos  1 , Voula Pylarinou  1 , Maria Drakopoulou  1 , Skevos Sideris  3 , Charalambos Vlachopoulos  1 , Dimitrios Tousoulis  1
Affiliations

Permanent pacemaker implantation in unexplained syncope patients with borderline sinus bradycardia and electrophysiology study-proven sinus node disease

Ioannis Doundoulakis et al. J Arrhythm. .

Abstract

Background: Significant sinus bradycardia (SB) in the context of sinus node dysfunction (SND) has been associated with neurological symptoms. The objective was to evaluate the effect of permanent pacing on the incidence of syncope in patients with rather mild degrees of SB, unexplained syncope, and "positive" invasive electrophysiologic testing.

Methods: This was an observational study based on a prospective registry of 122 consecutive mild SB patients (61.90 ± 18.28 years, 61.5% male, 57.88 ± 7.73 bpm) presenting with recurrent unexplained pre and syncope attacks admitted to our hospital for invasive electrophysiology study (EPS). Τhe implantation of a permanent antibradycardia pacemaker (ABP) was offered to all patients according to the results of the EPS. Eighty patients received the ABP, while 42 denied.

Results: The mean of reported syncope episodes was 2.23 ± 1.29 (or presyncope 2.36 ± 1.20) in the last 12 months before they were referred for a combined EP guided diagnostic and therapeutic approach. Over a mean follow-up of approximately 4 years (50.39 ± 32.40 months), the primary outcome event (syncope) occurred in 18 of 122 patients (14.8%), 6 of 80 (7.5%) in the ABP group as compared to 12 of 42 (28.6%) in the no pacemaker group (P = .002).

Conclusions: Among patients with mild degree of SB and a history of unexplained syncope, a set of positivity criteria for the presence of EPS defined SND after differentiating reflex syncope, identifies a subset of patients who will benefit from permanent pacing.

Keywords: electrophysiology study; sinus bradycardia; sinus node dysfunction; syncope.

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Conflict of interest statement

The authors declare no conflict of interest for this article.

Figures

FIGURE 1
FIGURE 1
Flow chart of study and outcomes
FIGURE 2
FIGURE 2
Kaplan‐Meier curves for syncope‐free survival according to permanent pacing status (primary endpoint)
FIGURE 3
FIGURE 3
Kaplan‐Meier curves for death from any cause according to permanent pacing status
See this image and copyright information in PMC

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