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Prevention of syncope through permanent cardiac pacing in patients with bifascicular block and syncope of unexplained

Massimo Santini1, Antonio Castro, Franco Giada

  • 1Azienda Ospedaliera S. Filippo Neri, Roma, Italy. m.santini@rmnet.it

Circulation. Arrhythmia and Electrophysiology
|February 8, 2013
PubMed

Insights

Permanent pacemaker programming with DDD60 significantly reduced syncope and symptoms in bifascicular block patients compared to DDI30. This study highlights effective pacing strategies for managing unexplained syncope in this population.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Syncope in patients with bifascicular block (BFB) presents diagnostic challenges.
  • Identifying the cause of syncope in BFB is crucial for effective management.

Purpose of the Study:

  • To evaluate the efficacy of permanent cardiac pacing in reducing symptomatic events in patients with BFB and syncope of undetermined origin.
  • To compare two pacemaker programming modes: DDD with a lower rate of 60 bpm (DDD60) versus DDI with a lower rate of 30 bpm (DDI30).

Main Methods:

  • A multicenter, prospective, randomized, single-blinded study (PRESS trial) enrolled 101 patients.
  • Patients with BFB and syncope were randomized to DDD60 or DDI30 pacing.
  • Primary endpoint events included syncope, symptomatic presyncope with device intervention, and symptomatic atrioventricular block.

Main Results:

  • A significant reduction in primary endpoint events at 2 years was observed in the DDD60 group (HR, 0.32; P=0.042).
  • Overall symptom reduction was superior in DDD60 compared to DDI30 (HR, 0.4; P=0.0053).
  • 15% of patients developed new rhythm diseases requiring pacing within 2 years.

Conclusions:

  • Dual-chamber pacing programmed to DDD60 significantly reduces syncope and cardioinhibitory symptoms in BFB patients compared to DDI30.
  • New onset of rhythm diseases requiring pacing occurred in 15% of the study population over 2 years.
Abstract

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