Key result
Temporary A-V pacing shows ~114% greater success in patients with cardioinhibitory versus mixed responses.
Why the study?
The relevance of different hemodynamic collapse patterns during tilt testing for planning therapy in neurocardiogenic syncope, particularly predicting benefit from pacing, was uncertain.
Does temporary A-V sequential pacing improve tilt test outcomes in patients with suspected neurocardiogenic syncope and a cardioinhibitory response?
Does temporary A-V sequential pacing improve tilt test outcomes in patients with suspected neurocardiogenic syncope and a cardioinhibitory response?
Absolute Event Rate: 76.5% vs 35.7%
p-value: p=0.024
A predominantly cardioinhibitory collapse pattern during baseline tilt testing identifies patients with neurocardiogenic syncope who are more likely to benefit from A-V sequential pacing.
May support tilt-guided selection for pacing trials in neurocardiogenic syncope; leaves open whether pacing improves clinical outcomes.
UNLABELLED: This study examined whether the various hemodynamic collapse patterns observed during tilt testing in patients with suspected neurocardiogenic syncope are relevant when planning therapy, particularly whether a predominantly cardioinhibitory response predicts a beneficial response from pacing. METHODS: The effects of temporary atrioventricular (A-V) sequential pacing were studied during tilt testing in 34 patients 48.2 +/- 18.5 years of age. The patient population was divided into a cardioinhibitory group (VASIS classes 2A and 2B) or mixed group (VASIS classes 1 and 3) according to their response to baseline tilt testing. The test was then repeated during A-V pacing with rate hysteresis. A positive response to A-V pacing was defined as a > or = 30-second increase between onset of symptoms and syncope, or mitigation of symptoms compared with the baseline tilt test. RESULTS: The study protocol was not successfully completed in three patients. Among the remaining 31 patients, a baseline cardioinhibitory response was observed in 17, and a mixed response in 14 patients. A-V sequential pacing was successful in 13 of 17 patients with a cardioinhibitory response versus 5 of 14 patients with a mixed response (P = 0.024). CONCLUSION: The presence of a predominantly cardioinhibitory collapse pattern (VASIS 2A and 2B) during baseline tilt testing doubled the likelihood of successful temporary A-V sequential pacing, and may identify patients with neurocardiogenic syncope most likely to benefit from permanent dual chamber pacing.
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Kurbaan et al. (2000) studied Suspected neurocardiogenic syncope (n=34). Temporary atrioventricular (A-V) sequential pacing vs. Mixed response group (VASIS classes 1 and 3) was evaluated on Positive response to A-V pacing (≥30-second increase between onset of symptoms and syncope, or mitigation of symptoms compared with baseline) (p=0.024). Temporary A-V sequential pacing was successful in 76.5% of patients with a baseline cardioinhibitory response compared to 35.7% of patients with a mixed response (P=0.024).
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