Related Experiment Videos
Ventricular and dual chamber pacing for treatment of carotid sinus syndrome
M Brignole1, B Sartore, M Barra
1Laboratory of Clinical Electrophysiology and Pacing, Hospital of Lavagna, Genoa, Italy.
Insights
Ventricular (VVI) pacing effectively treats recurrent syncope in carotid sinus syndrome. Dual chamber pacing (DDD/DVI) is preferred when VVI pacing fails due to specific patient factors like orthostatic hypotension.
Area of Science:
- Cardiology
- Neurology
Background:
- Recurrent syncope can significantly impact quality of life.
- Carotid sinus syndrome (CSS) is a common cause of syncope, particularly in older adults.
- Cardioinhibitory and mixed CSS types often require pacing interventions.
Purpose of the Study:
- To evaluate the efficacy of ventricular (VVI) and dual-chamber (DDD/DVI) pacing in patients with recurrent syncope due to carotid sinus syndrome.
- To identify predictors of VVI pacing failure and determine optimal pacing strategies.
Main Methods:
- A study of 39 consecutive patients with recurrent syncope and CSS (excluding isolated vasodepressor form).
- Patients received either VVI pacing (n=16) or DDD/DVI pacing (n=23).
- Follow-up of 12 months with VVI pacing initial evaluation, followed by dual-chamber comparison where applicable.
Main Results:
- Overall symptom elimination in 67% and improvement in 33% of patients.
- VVI pacing failure was associated with symptomatic pacemaker effect, mixed CSS, orthostatic hypotension, and ventriculoatrial conduction.
- Dual-chamber pacing was preferred by 14 patients over VVI, with similar factors predicting preference.
Conclusions:
- VVI pacing is effective for many patients with cardioinhibitory or mixed CSS.
- Identifying specific patient factors aids in selecting VVI versus dual-chamber pacing for optimal outcomes.
- Dual-chamber pacing is recommended for patients with VVI pacing failure predictors.
Abstract:
Thirty-nine consecutive patients with recurrent syncope and either cardioinhibitory or mixed type carotid sinus syndrome were studied to determine the efficacy of ventricular (VVI) pacing in 16, and dual chamber (DDD/DVI) in 23 patients. Only those patients affected by the isolated vasodepressor form were excluded. Follow-up lasted 12 +/- 5 months. Symptoms were totally eliminated in 67% of patients and ameliorated with persistence of minor symptoms in 33%. All patients underwent an initial 2-month follow-up in the VVI mode. Evaluation of the 19 patients who remained symptomatic and the 20 who became asymptomatic with VVI pacing demonstrated that factors observed prior to pacemaker implant were related to failure of the VVI mode. These included symptomatic pacemaker effect (42% vs 0%), mixed carotid sinus syndrome (95% vs 65%), orthostatic hypotension (47% vs 15%), or ventriculoatrial conduction (68% vs 38%). In the 23 patients with dual chamber pacing, random 2 month comparisons were performed between VVI and DVI/DDD pacing. The dual chamber mode was preferred by 14 patients, none preferred the VVI mode and nine noted no difference. Comparison of the two groups found that the factors linked to DVI/DDD preference were symptomatic pacemaker effect (50% vs 0%), ventriculoatrial conduction (78% vs 44%), or orthostatic hypotension (50% vs 11%). VVI pacing is efficacious in a high proportion of patients affected by cardioinhibitory or mixed carotid sinus syndrome. The identification of causes of VVI pacing failure allows determination of those who will benefit from VVI pacing and those who should have DVI/DDD. VVI pacing is suggested for the cardioinhibitory type with no symptomatic pacemaker effect and for the mixed type with no symptomatic pacemaker effect or orthostatic hypotension or ventriculoatrial conduction. Dual chamber pacing should be used in all other instances.