Follow-up of asystolic episodes in patients with cardioinhibitory, neurally mediated syncope and VVI pacemaker
Abstract
The occurrence rate of spontaneous asystolic episodes during long-term follow-up in patients with abnormal asystolic responses induced by means of vasovagal maneuvers was evaluated. The heart rate of 23 patients (mean age 64 +/- 12 years; 6 women and 17 men) affected by neurally mediated syncope (mean 4.3 +/- 4.9 episodes) was continuously monitored by a specially designed implanted pacemaker able to detect and store in its memory all asystolic episodes lasting 3 to 6 or > 6 seconds. Asystolic, neurally mediated syncope was diagnosed when a reflex asystole of > 3 seconds was induced during carotid sinus massage (n = 22), eyeball compression test (n = 3) or head-up tilt test (n = 2). During a total of 357 months (mean 15 +/- 7) of monitoring, asystolic episodes occurred in 17 patients (74%): 1,765 episodes of 3- to 6-second (median 3) duration occurred in 14 patients, and 47 episodes of > 6-second (median 2) duration occurred in 11. The actuarial estimates of occurrence of asystolic episodes of > 3 and > 6 seconds were 82 and 53%, respectively, after 2 years of follow-up. Only 12 episodes of 3 to 6 seconds (0.7%), and 20 episodes of > 6 seconds (43%) resulted in presyncopal or syncopal symptoms. Thus, an asystolic response to vasovagal maneuvers predicts the occurrence of spontaneous asystolic episodes during follow-up. With few exceptions, spontaneous episodes are asymptomatic and their incidence is low.
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The diagnosis of carotid sinus syndrome requires both the reproduction of spontaneous symptoms during carotid sinus massage and clinical features of spontaneous syncope compatible with a reflex mechanism.
“There is strong consensus that the diagnosis of CSS requires both the reproduction of spontaneous symptoms during CSM and clinical features of spontaneous syncope compatible with a reflex mechanism.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [100]
Recordings of long pauses were very common in the two trials that employed implanted device monitoring in patients with a cardioinhibitory response to carotid sinus massage.
“Recordings of long pauses were very common in the two trials that employed this method. 100,101”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [100]
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- Authors
- Menozzi, C., Brignole, M., Lolli, G., Bottoni, N., Oddone, D., Gianfranchi, L., & Gaggioli, G.
- Affiliations
- Santa Maria Nuova Hospital (IT)
- Corresponding author
- Brignole, Michele
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 1993-11
- Volume
- 72
- Issue
- 15
- Pages
- 1152-1155
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2009711359
- Cited by
- 93
- References
- 19
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 4 · 2018: 4 · 2016: 2 · 2015: 3 · 2014: 7 · 2013: 2 · 2012: 1
- FWCI
- 1.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- neurally mediated syncope, cardioinhibitory syncope, VVI pacemaker, carotid sinus massage, head-up tilt, long-term follow-up, pacemaker monitoring
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Heart Arrest, Heart Rate, Humans, Male, Middle Aged, Pacemaker, Artificial, Predictive Value of Tests, Prospective Studies, Syncope, Vagus Nerve, Electrocardiography, Ambulatory, Life Tables
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