Method of pacing does not affect the recurrence of syncope in carotid sinus syndrome

Christopher J McLeod1, Jane M Trusty, Sarah M Jenkins

  • 1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.

Insights

Pacemaker therapy effectively reduces syncope in carotid sinus hypersensitivity (CSH) patients. However, this study found no significant difference in effectiveness between VVI, DDDR, and DDDR with sudden bradycardia response (SBR) pacing modes.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Carotid sinus hypersensitivity (CSH) causes recurrent syncope.
  • Pacemaker therapy is a known treatment for symptomatic CSH.
  • Optimal pacemaker pacing modality for CSH remains undetermined.

Purpose of the Study:

  • To prospectively compare three pacemaker pacing modalities: VVI, DDDR, and DDDR with sudden bradycardia response (SBR).
  • To evaluate the impact of these pacing methods on recurrent syncope and patient quality of life.

Main Methods:

  • Twenty-one symptomatic CSH patients were enrolled.
  • A double-blinded, sequential crossover design was used, with 6 months in each pacing mode (VVI, DDDR, DDDR with SBR).
  • Primary endpoints included recurrent syncopal events and quality of life (SF-36 scores).

Main Results:

  • All pacing modes significantly reduced syncopal and presyncopal events compared to baseline.
  • No significant difference in event reduction was observed between VVI, DDDR, and DDDR with SBR pacing.
  • Quality of life scores showed minor improvements with DDDR pacing but no method was superior.

Conclusions:

  • The study did not confirm the superiority of any single pacing modality over others for CSH.
  • DDDR pacing alone may offer some quality-of-life benefits.
  • Further research is needed to determine the optimal pacing strategy for CSH.
Abstract

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