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April 7, 2014Heart

Syncope in paced patients with sick sinus syndrome from the DANPACE trial: incidence, predictors and prognostic implication

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Key result

Syncope after pacemaker implantation in sick sinus syndrome is linked to ~60% higher mortality.

  • n=1,415

Why the study?

What are the incidence, predictors, and prognostic implications of syncope in paced patients with sick sinus syndrome?

Population

1,415 patients with sick sinus syndrome (SSS), mean age 72.9 years

Design

Cohort, Randomised in the DANPACE study to either rate-responsive single…

Follow-up

Mean 5.4 years (SD 2.6)

Authors

MCMarie Jennyfer Ng Kam ChuenNottingham University Hospitals NHS TrustRKRikke Esberg KirkfeldtOdense City MuseumsHAHenning AndersenAarhus University Hospital

Discussion

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Overview

Syncope post-pacemaker in sick sinus syndrome identifies higher-risk patients; leaves open whether targeted evaluation improves outcomes.

Key Points

  • The research aims to assess the incidence, predictors, and prognostic implications of syncope in patients with sick sinus syndrome receiving pacemaker therapy.
  • 1415 patients with sick sinus syndrome were randomized in the DANPACE trial to single or dual chamber pacing.
  • The main outcome measures included patient-reported syncope rates and mortality.
  • Mean follow-up duration was 5.4 years.
  • A total of 247 (17.5%) patients experienced syncope after pacemaker implantation.
  • Predictors of syncope included younger age (0-39 years, HR 2.9), older age (≥80 years, HR 1.4), prior syncope (HR 1.8), and higher comorbidity index (HR 1.6).
  • Patients with post-implantation syncope had a higher mortality risk (adjusted HR 1.6).

Study Design

Type

RCT (n=1,415)

Randomization

Randomized

Structured PICO

What are the incidence, predictors, and prognostic implications of syncope in paced patients with sick sinus syndrome?

P
Population
1,415 patients with sick sinus syndrome (SSS), mean age 72.9 years
I
Intervention
Rate-responsive single chamber pacing (n=707) or rate-responsive dual chamber pacing (n=708)
O
Outcome
Patient-reported syncope after pacemaker implantation and mortalitypatient reported

Main Result

Absolute Event Rate: 19% vs 15.8%

Syncope remains common in paced patients with sick sinus syndrome and is associated with increased mortality, suggesting a multifactorial etiology beyond bradycardia.

Cite This Study

Chuen et al. (2014) conducted an RCT in Sick sinus syndrome (n=1,415). Rate-responsive single chamber pacing vs. Rate-responsive dual chamber pacing was evaluated on Patient-reported syncope after pacemaker implantation. Syncope after pacemaker implantation in patients with sick sinus syndrome occurred in 17.5% of patients and was associated with higher mortality (adjusted HR 1.6; 95% CI 1.3-2.1; p<0.001).

synapsesocial.com/papers/6a07b44144ff8ad339f69a9fhttps://doi.org/10.1136/heartjnl-2013-304976
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1A comparison of single-lead atrial pacing with dual-chamber pacing in sick sinus syndrome2011 · 302 citations
  2. 2Survival and Follow‐up After Pacemaker Implantation: A Comparison of Patients With Sick Sinus Syndrome, Complete Heart Block, and Atrial Fibrillation1985 · 78 citations
  3. 32013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy2013 · 2,821 citations
  4. 42013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: The Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA)2013 · 1,135 citations
  5. 52012 ACCF/AHA/HRS Focused Update Incorporated Into the ACCF/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities2012 · 734 citations