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DDDR pacing driven by contractility versus DDI pacing in vasovagal syncope: a multicenter, randomized study.
Jean-Claude Deharo1, Alberto Borri Brunetto, Fulvio Bellocci
1Cardiology Dept., Sainte-Marguerite University Hospital of Marseilles, 270 Bd Sainte-Marguerite, 13008 Marseille, France. jean-claude.deharo@ap-hm.fr
Pacing and Clinical Electrophysiology : PACE
|April 12, 2003
Summary
Permanent cardiac pacing with rate-adaptive DDDR technology significantly reduced syncope and presyncope episodes in patients with recurrent vasovagal syncope (VVS). This pacing method proved more effective than conventional DDI pacing, though quality of life remained similar.
Area of Science:
- Cardiology
- Neuroscience
- Biomedical Engineering
Background:
- Recurrent vasovagal syncope (VVS) can significantly impact patient quality of life.
- Selected VVS patients may benefit from permanent cardiac pacing.
- Previous research indicated sympathetic activity preceding syncope can be detected by pacemakers.
Purpose of the Study:
- To compare the efficacy of DDDR pacing driven by a microaccelerometer with conventional DDI pacing in patients with recurrent VVS.
- To assess the impact of these pacing modes on syncope/presyncope episodes and quality of life.
Main Methods:
- A single-blind, randomized crossover study involving 23 patients with recurrent VVS.
- Patients received a "MiniLivingD/Best" pacing system and were randomized to DDDR or DDI pacing for 6-month periods.
- Inclusion criteria included a history of syncope and a positive head-up tilt test (HUT) with bradycardia.
Main Results:
- DDDR pacing resulted in significantly fewer syncope/presyncope episodes (0.09/patient) compared to DDI pacing (0.48/patient) (P < 0.05).
- The mean number of syncopal episodes in the 6 months prior to implantation was 3.2.
- Quality of life scores were not significantly different between the DDDR and DDI pacing modes.
Conclusions:
- Contractility-driven DDDR pacing is more effective than DDI pacing in reducing symptomatic recurrences in patients with recurrent VVS.
- While DDDR pacing reduces syncope frequency, it does not significantly improve quality of life compared to DDI pacing in this patient group.