Standardized algorithm for cardiac pacing in older patients affected by severe unpredictable reflex syncope: 3-year insights from the Syncope Unit Project 2 (SUP 2) study
Standardized algorithm for cardiac pacing in older patients affected by severe unpredictable reflex syncope: 3-year insights from the Syncope Unit Project 2 (SUP 2) study
复制标题
DOI：
10.1093/europace/euv343
复制
发表时间：
2016-09-01
期刊：
影响因子：
6.1
通讯作者：
Gaggioli, Germano
中科院分区：
文献类型：
--
作者：
Brignole, Michele;Arabia, Francesco;Gaggioli, Germano
目的本研究的目的是确定在晕厥单元项目2（晕厥2）研究中受反射性晕厥影响的患者中心脏起搏的长期效果和成功的决定因素。初步结果已经验证了一个标准化的基于指南的算法，可用于临床实践中，以选择合适的候选人心脏pacemaking.Methods和结果在这个前瞻性，多中心，观察性研究，患者年龄>40岁，受严重不可预测的复发性反射晕厥，进行颈动脉窦按摩（CSM），然后倾斜试验（TT），如果CSM是阴性的，如果TT为阴性，则植入植入式循环记录器（ILR）。那些对这些测试之一有心搏停止反应的人接受了双腔起搏器。在符合入选标准的281例患者中，137例（49%）植入了起搏器，平均随访26 ± 11个月：其中25例（18%）晕厥复发。3年时，晕厥复发率为20% [95%置信区间（CI）12-30]，显著低于未植入起搏器并通过ILR观察的142例患者[43%（95% CI 29-57），P = 0.01]。78例CSM+、38例TT+和21例ILR+患者的3年复发率无差异，而20例TT阴性患者的3年复发率较低[5%]。（95% CI 0-15）]比61例TT阳性患者[24%结论心脏起搏的益处可维持3年，无论采用何种指标诊断试验，TT阴性患者的益处最大。
Aims The aim of this study was to determine the long-term effects and determinants of success of cardiac pacing in patients affected by reflex syncope enrolled in the Syncope Unit Project 2 (SUP 2) study. Initial results have validated the effectiveness of a standardized guideline-based algorithm which can be used in clinical practice in order to select suitable candidates for cardiac pacing.Methods and results In this prospective, multicentre, observational study, patients aged >40 years, affected by severe unpredictable recurrent reflex syncope, underwent carotid sinus massage (CSM), followed by tilt testing (TT) if CSM was negative, followed by implantation of an implantable loop recorder (ILR) if TT was negative. Those who had an asystolic response to one of these tests received a dual-chamber pacemaker. Of 281 patients who met the inclusion criteria, 137 (49%) received a pacemaker and were followed up for a mean of 26 +/- 11 months: syncope recurred in 25 (18%) of them. At 3 years, the actuarial syncope recurrence rate was 20% [95% confidence interval (CI) 12-30] and was significantly lower than in 142 patients who did not receive a pacemaker and were observed by means of an ILR [43% (95% CI 29-57), P = 0.01]. The 3-year recurrence rate was not different among 78 CSM+, 38 TT+, and 21 ILR+ patients, whereas it was lower in 20 patients with negative TT [5% (95% CI 0-15)] than in 61 patients with positive TT [24% (95% CI 10-38)].Conclusion The benefit of cardiac pacing is maintained at 3 years, irrespective of the index diagnostic test, and is maximum in patients with negative TT.