Causes of syncopal recurrences in patients treated with permanent pacing for bradyarrhythmic syncope : Findings from the SYNCOPACED registry

Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved..

BACKGROUND: Few studies have examined the causes of syncope/collapse recurrences in patients with a previously implanted pacemaker for bradyarrhythmic syncope.

OBJECTIVE: The purpose of this study was to assess the causes of syncope/collapse recurrences after pacemaker implantation for bradyarrhythmic syncope in a large patient population.

METHODS: The SYNCOpal recurrences in patients treated with permanent PACing for bradyarrhythmic syncope (SYNCOPACED) registry was a prospective multicenter observational registry enrolling 1364 consecutive patients undergoing pacemaker implantation for bradyarrhythmic syncope. During follow-up, the time to the first syncope/collapse recurrence was recorded. Patients with syncope/collapse recurrences underwent a predefined diagnostic workup aimed at establishing the mechanism of syncope/collapse.

RESULTS: During a median follow-up of 50 months, 213 patients (15.6%) reported at least 1 syncope/collapse recurrence. The risk of syncope/collapse recurrence was highest in patients who underwent implantation for cardioinhibitory vasovagal syncope (26.4%), followed by unexplained syncope and chronic bifascicular block (21.5%), cardioinhibitory carotid sinus syndrome (17.2%), atrial fibrillation needing pacing (15.5%), atrioventricular block (13.6%), and sinus node disease (12.5%) (P = .017). The most frequent cause of syncope/collapse recurrence was reflex syncope (27.7%), followed by orthostatic hypotension (26.3%), pacemaker or lead malfunction (5.6%), structural cardiac disease (5.2%), and atrial and ventricular tachyarrhythmias (4.7% and 3.8%, respectively). In 26.8% of cases, the mechanism of syncope/collapse remained unexplained.

CONCLUSION: In patients receiving a pacemaker for bradyarrhythmic syncope, reflex syncope and orthostatic hypotension are the most frequent mechanisms of syncope/collapse recurrence after implantation. Pacing system malfunction, structural cardiac diseases, and tachyarrhythmias are rare mechanisms. The mechanism remains unexplained in >25% of patients.

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:18

Enthalten in:

Heart rhythm - 18(2021), 5 vom: 15. Mai, Seite 770-777

Sprache:

Englisch

Beteiligte Personen:

Palmisano, Pietro [VerfasserIn]
Dell'Era, Gabriele [VerfasserIn]
Pellegrino, Pier Luigi [VerfasserIn]
Ammendola, Ernesto [VerfasserIn]
Ziacchi, Matteo [VerfasserIn]
Guerra, Federico [VerfasserIn]
Aspromonte, Vittorio [VerfasserIn]
Laffi, Mattia [VerfasserIn]
Pimpini, Lorenzo [VerfasserIn]
Santoro, Francesco [VerfasserIn]
Boggio, Enrico [VerfasserIn]
Guido, Alessandro [VerfasserIn]
Patti, Giuseppe [VerfasserIn]
Brunetti, Natale Daniele [VerfasserIn]
Nigro, Gerardo [VerfasserIn]
Biffi, Mauro [VerfasserIn]
Russo, Antonio Dello [VerfasserIn]
Gaggioli, Germano [VerfasserIn]
Accogli, Michele [VerfasserIn]
of the Italian Association of Arrhythmology and Cardiac Pacing [VerfasserIn]

Links:

Volltext

Themen:

Bradyarrhythmia
Causes of syncope
Journal Article
Multicenter Study
Observational Study
Pacemaker
Syncopal recurrence
Syncope
Treatment of syncope

Anmerkungen:

Date Completed 18.01.2022

Date Revised 18.01.2022

published: Print-Electronic

Citation Status MEDLINE

doi:

10.1016/j.hrthm.2021.01.010

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM320279391