Open AccessPermanent pacemaker implantation in unexplained syncope patients with borderline sinus bradycardia and electrophysiology study‐proven sinus node disease
Author(s) -
Doundoulakis Ioannis,
Gatzoulis Konstantinos A.,
Arsenos Petros,
Dilaveris Polychronis,
Skiadas Ioannis,
Tsiachris Dimitrios,
Antoniou ChristosKonstantinos,
Soulaidopoulos Stergios,
Karystinos George,
Pylarinou Voula,
Drakopoulou Maria,
Sideris Skevos,
Vlachopoulos Charalambos,
Tousoulis Dimitrios
Publication year - 2021
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1002/joa3.12460
Subject(s) - medicine , presyncope , syncope (phonology) , bradycardia , context (archaeology) , sinus bradycardia , sinus (botany) , cardiology , incidence (geometry) , sick sinus syndrome , anesthesia , heart rate , blood pressure , paleontology , botany , physics , optics , biology , genus
Abstract Background Significant sinus bradycardia (SB) in the context of sinus node dysfunction (SND) has been associated with neurological symptoms. The objective was to evaluate the effect of permanent pacing on the incidence of syncope in patients with rather mild degrees of SB, unexplained syncope, and “positive” invasive electrophysiologic testing. Methods This was an observational study based on a prospective registry of 122 consecutive mild SB patients (61.90 ± 18.28 years, 61.5% male, 57.88 ± 7.73 bpm) presenting with recurrent unexplained pre and syncope attacks admitted to our hospital for invasive electrophysiology study (EPS). Τhe implantation of a permanent antibradycardia pacemaker (ABP) was offered to all patients according to the results of the EPS. Eighty patients received the ABP, while 42 denied. Results The mean of reported syncope episodes was 2.23 ± 1.29 (or presyncope 2.36 ± 1.20) in the last 12 months before they were referred for a combined EP guided diagnostic and therapeutic approach. Over a mean follow‐up of approximately 4 years (50.39 ± 32.40 months), the primary outcome event (syncope) occurred in 18 of 122 patients (14.8%), 6 of 80 (7.5%) in the ABP group as compared to 12 of 42 (28.6%) in the no pacemaker group ( P = .002). Conclusions Among patients with mild degree of SB and a history of unexplained syncope, a set of positivity criteria for the presence of EPS defined SND after differentiating reflex syncope, identifies a subset of patients who will benefit from permanent pacing.