Benefit of Pacemaker Therapy in Patients With Presumed Neurally Mediated Syncope and Documented Asystole Is Greater When Tilt Test Is Negative
Key result
Cardiac pacing in patients with neurally mediated syncope and documented asystole resulted in a 5% syncope recurrence rate in those with a negative tilt test versus 55% in those with a positive tilt test (P=0.004).
Why the study?
Does cardiac pacing reduce syncope recurrence in patients with presumed neurally mediated syncope and documented asystole, and is this effect modified by tilt test results?
Study Design
Type
RCT (n=136)
Multicenter
Yes
Structured PICO
Does cardiac pacing reduce syncope recurrence in patients with presumed neurally mediated syncope and documented asystole, and is this effect modified by tilt test results?
P
Population
136 patients with presumed neurally mediated syncope and documented asystole, followed for up to 21 months.
I
Intervention
Cardiac pacing (pacemaker)
C
Comparator
Untreated patients (control group, n=45) and comparison between tilt test positive (TT+) and tilt test negative (TT-) patients
O
Outcome
Recurrence of syncope at 21 monthshard clinical
Main Result
Absolute Event Rate: 5% vs 55%
p-value: p=0.004
Pacemaker therapy is highly effective in preventing syncope recurrence in patients with neurally mediated syncope and documented asystole who have a negative tilt test, but may lack efficacy in those with a positive tilt test.
Limitations
- Present observations are unexpected and need to be confirmed by other studies.
- Present observations are unexpected and need to be confirmed by other studies
Authors
Discussion
No takes yet. Share an insight, caveat, or question.
Implication
Negative tilt test may identify pacing responders in neurally mediated syncope with asystole; leaves open efficacy and requires randomized confirmation.
Cite This Study
Brignole et al. (2013) conducted an RCT in Presumed neurally mediated syncope with documented asystole (n=136). Cardiac pacing vs. Tilt test positive patients / untreated controls was evaluated on Syncope recurrence (p=0.004). Cardiac pacing in patients with neurally mediated syncope and documented asystole resulted in a 5% syncope recurrence rate in those with a negative tilt test versus 55% in those with a positive tilt test (P=0.004).