Pacing as a Treatment for Reflex-Mediated (Vasovagal, Situational, or Carotid Sinus Hypersensitivity) Syncope: A Systematic Review for the 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society
Why the study?
Does pacing reduce recurrent syncope in adult patients with reflex-mediated syncope?
Population
676 adult patients with reflex-mediated syncope across 10 studies.
Comparison
Pacing vs Control
Design
Systematic_review, 9 randomized trials and 1 observational study included, 6…
Authors
Discussion
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Implication
Blinded evidence does not support pacing for reflex-mediated syncope; challenges open-label benefits and reinforces medical management.
Study Design
Type
Systematic Review (n=676)
Structured PICO
Does pacing reduce recurrent syncope in adult patients with reflex-mediated syncope?
P
Population
676 adult patients with reflex-mediated syncope included across 10 studies (9 randomized trials and 1 observational study).
I
Intervention
Pacing
C
Comparator
Control (not explicitly detailed, implied standard care or no pacing)
O
Outcome
Recurrent syncopehard clinical
Main Result
Relative Risk: 0.73 (95% CI 0.25–2.1)
Evidence does not support the use of pacing for reflex-mediated syncope beyond patients with recurrent vasovagal syncope and asystole documented by an implantable loop recorder.
Limitations
- Limited data with substantive evidence of outcome ascertainment bias
- Only 2 studies with a double-blinded study design have been conducted
Cite This Study
Varosy et al. (2017) conducted a systematic review in reflex-mediated syncope (n=676). Pacing vs. Control was evaluated on recurrent syncope (RR 0.73, 95% CI 0.25-2.1). Pacing did not significantly reduce recurrent syncope in double-blinded studies of patients with reflex-mediated syncope (RR 0.73; 95% CI 0.25-2.1), despite apparent benefit in open-label trials.