Permanent pacemaker implantation in octogenarians with unexplained syncope and positive electrophysiologic testing

Area of Science:

• Cardiology
• Geriatrics
• Electrophysiology

Background:

• Syncope is a prevalent issue in the elderly population.
• Permanent pacemaker implantation is a therapeutic option for syncope with a confirmed bradycardic cause.
• The efficacy of pacing for unexplained syncope without a clear bradycardic association, particularly in older adults, remains uncertain.

Purpose of the Study:

• To investigate the impact of pacemaker implantation on syncope-free mortality in patients aged 80 years and above presenting with unexplained syncope and positive invasive electrophysiologic testing (EPT).

Main Methods:

• An observational study design was employed.
• Positive EPT was defined by specific criteria including corrected sinus node recovery time (>525 ms), basic HV interval (>55 ms), infra-Hisian block, or second-degree atrioventricular block during decremental atrial pacing (>400 ms).
• Kaplan-Meier analysis was used to compare outcomes between patients with and without pacemakers.

Main Results:

• Out of 2435 screened patients, 228 were eligible, with 145 receiving pacemakers.
• Pacemaker recipients experienced a longer time to syncope or death (50.1 months) compared to non-recipients (37.8 months) (P = .001).
• The 4-year incidence of syncope was significantly lower (12% vs. 44%, P < .001) and all-cause mortality was also reduced (41% vs. 56%, P = .023) in the pacemaker group.

Conclusions:

• Pacemaker implantation is independently associated with improved syncope-free survival in elderly patients with unexplained syncope and evidence of sinus node dysfunction or atrioventricular conduction abnormalities on EPT.
• The study demonstrated significant benefits in both syncope recurrence and overall mortality.
• These findings support the use of pacing in carefully selected elderly patients with unexplained syncope and positive EPT results.