Risk of syncopal recurrences in patients treated with permanent pacing for bradyarrhythmic syncope: role of correlation between symptoms and electrocardiogram findings
Risk of syncopal recurrences in patients treated with permanent pacing for bradyarrhythmic syncope: role of correlation between symptoms and electrocardiogram findings
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DOI：
10.1093/europace/euaa188
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发表时间：
2020-11-01
期刊：
影响因子：
6.1
通讯作者：
Dell'Era, Gabriele
中科院分区：
文献类型：
--
作者：
Palmisano, Pietro;Pellegrino, Pier Luigi;Dell'Era, Gabriele
Aims To evaluate the risk of syncopal recurrence after pacemaker implantation in a population of patients with syncope of suspicious bradymic aeology.Methods and results Prospective，multicentre，observational registry enrolling 1364 continuous pacemaker implantation for syncope of bradymic aeology. Methods and results（已证实或推定）.在植入起搏器之前，所有患者都接受了心脏检查，以确定晕厥的心动过缓病因。根据诊断检查结果，将患者分为三组：A组，晕厥与心电图（ECG）相关的患者（n = 329，24.1%）; B组，检测到具有临床意义的缓慢性心律失常，但未记录到晕厥-ECG相关性（n= 877，64.3%）; C组，未检测到缓慢性心律失常且仍假定晕厥的缓慢性起源的患者（n = 158，11.6%）。在平均50个月的随访中，213例患者（15.6%）报告至少有一次晕厥复发。B组和C组患者晕厥复发的风险显著高于A组[危险比（HR）分别为1.60和166，P < 0.05]。多变量分析显示，在起搏器植入前的诊断检查期间未能建立晕厥与心电图的相关性是晕厥复发的独立预测因素结论在选择疑有心动过缓病因的晕厥患者行起搏器植入术时，建立晕厥与心动过缓的相关性，可最大限度地提高起搏的疗效，降低晕厥复发的风险。
Aims To evaluate the risk of syncopal recurrences after pacemaker implantation in a population of patients with syncope of suspected bradyarrhythmic aetiology.Methods and results Prospective, multicentre, observational registry enrolling 1364 consecutive patients undergoing pacemaker implantation for syncope of bradyarrhythmic aetiology (proven or presumed). Before pacemaker implantation, all patients underwent a cardiac work-up in order to establish the bradyarrhythmic aetiology of syncope. According to the results of the diagnostic work-up, patients were divided into three groups: Group A, patients in whom a syncope-electrocardiogram (ECG) correlation was established (n = 329, 24.1%); Group B, those in whom clinically significant bradyarrhythmias were detected without a documented syncope-ECG correlation (n= 877, 64.3%); and Group C, those in whom bradyarrhythmias were not detected and the bradyarrhythmic origin of syncope remained presumptive (n = 158, 11.6%). During a median follow-up of 50 months, 213 patients (15.6%) reported at least one syncopal recurrence. Patients in Groups B and C showed a significantly higher risk of syncopal recurrences than those in Group A [hazard ratios (HRs): 1.60 and 166, respectively, P < 0.05]. Failure to establish a syncope-ECG correlation during diagnostic work-up before pacemaker implantation was an independent predictor of syncopal recurrence on multivariate analysis (HR: 1.90; P= 0.002).Conclusion In selecting patients with syncope of suspected bradyarrhythmic aetiology for pacemaker implantation, establishing a correlation between syncope and bradyarrhythmias maximizes the efficacy of pacing and reduces the risk of syncopal recurrences.