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Pacing in elderly recurrent fallers with carotid sinus hypersensitivity: a randomised, double-blind, placebo
S W Parry1, N Steen, R S Bexton
1Falls and Syncope Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK. swparry@hotmail.com
Insights
Dual-chamber pacing did not reduce fall rates in patients with carotid sinus hypersensitivity (CSH). This study found no significant difference in falls between pacing on and off modes, suggesting further research is needed.
Area of Science:
- Cardiology
- Geriatrics
- Neurology
Background:
- Carotid sinus syndrome (CSS) is characterized by hypersensitivity (CSH) and syncope.
- The role of pacing in CSH patients with recurrent falls remains unclear.
- This study addresses the uncertainty surrounding dual-chamber pacing for CSH-related falls.
Purpose of the Study:
- To evaluate the efficacy of dual-chamber pacing in reducing falls in older adults with CSH.
- To clarify the role of complex pacing in managing unexplained falls in CSH patients.
Main Methods:
- Randomized, double-blind, crossover, placebo-controlled trial.
- Involved 34 patients over 55 with CSH and recurrent unexplained falls.
- Compared 6 months of active pacing (DDD/RDR) versus placebo (ODO).
Main Results:
- Pacing intervention showed no significant effect on the number of falls.
- The relative risk of falling in placebo mode was 0.82 (95% CI 0.62 to 1.10).
- Twenty-five participants completed the study, with a mean age of 76.8 years.
Conclusions:
- Permanent dual-chamber pacing does not reduce fall rates in older patients with CSH.
- Further research is essential to determine the potential benefits of complex pacing in this population.
Objectives:
While carotid sinus syndrome (CSS) is traditionally defined by the association of carotid sinus hypersensitivity (CSH) with syncope, uncertainty remains over the role, if any, of complex pacing in patients with CSH and unexplained or recurrent falls. We sought to clarify the role of dual chamber pacing in this patient group in the first placebo-controlled study in CSH.
Design:
Randomised, double-blind, crossover, placebo-controlled trial.
Setting:
Specialist falls and syncope facility.
Patients:
Consecutive subjects aged over 55 years with CSH as the sole attributable cause of three or more unexplained falls in the 6 months preceding enrolment.
Intervention:
Dual-chamber permanent pacing with rate-drop response programming. The pacemaker was switched on (DDD/RDR) or off (ODO (placebo)) for 6 months, then crossed over to the alternate mode for a further 6 months, in randomised, double-blind fashion.
Main Outcome Measure:
The primary outcome measure was number of falls in paced and non-paced modes.
Results:
Twenty-five of 34 subjects (mean 76.8 years (SD 9.0), 27 (79%) female) recruited completed the study. Pacing intervention had no effect on number of falls (4.04 (9.54) in DDD/RDR mode, 3.48 (7.22) in ODO; relative risk of falling in ODO mode 0.82, 95% CI 0.62 to 1.10).
Conclusion:
Permanent pacing intervention had no effect on fall rates in older patients with CSH. Further work is urgently needed to clarify the role, if any, of complex pacing in this patient group.
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