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A randomized, double-blind, placebo-controlled study of permanent cardiac pacing for the treatment of recurrent tilt-induced vasovagal syncope. The vasovagal syncope and pacing trial (SYNPACE)
Open accessAbstract
AIMS: Recently, some studies revealed the efficacy of pacemaker implantation in decreasing recurrences in patients with vasovagal syncope. As these studies were not blinded or placebo-controlled, the benefits observed might have been due to a bias in the assessment of outcomes or to a placebo effect of the pacemaker. We performed a randomized, double-blind, placebo-controlled study in order to ascertain if pacing therapy reduces the risk of syncope relapse. METHODS AND RESULTS: Twenty-nine patients (53 +/- 16 years; 19 women) with severe recurrent tilt-induced vasovagal syncope (median 12 syncopes in the lifetime) and 1 syncopal relapse after head-up tilt testing underwent implantation of a pacemaker, and were randomized to pacemaker ON or to pacemaker OFF. During a median of 715 days of follow-up, 8 (50%) patients randomized to pacemaker ON had recurrence of syncope compared to 5 (38%) of patients randomized to pacemaker OFF (p = n.s.); the median time to first syncope was longer in the pacemaker ON than in pacemaker OFF group, although not significantly so (97 [38-144] vs 20 [4-302] days; p = 0.38). There was also no significant difference in the subgroups of patients who had had a mixed response and in those who had had an asystolic response during head-up tilt testing. CONCLUSION: Our data were unable to show a superiority of active pacing versus inactive pacing in preventing syncopal recurrence in patients with severe recurrent tilt-induced vasovagal syncope.
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“Although earlier observational, open-label, and single-blind studies have been uniformly positive, the results of 2 subsequent double-blind studies in adults were negative.133–138”
From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [137]
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“In this study, and in the similarly designed SYNPACE trial, no reduction in syncope was seen [30] .”
From Evaluating and managing bradycardia (2020) · cites this paper as [30]
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“In general, pacing was ineffective in trials that enrolled patients without an asystolic tilt response. 299,300”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [300]
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Cites
Guidelines on management (diagnosis and treatment) of syncope
Brignole, M. (2001) · European Heart Journal · doi:10.1053/euhj.2001.2739 · Cited by 951
Self-citationConnolly, S. J., Sheldon, R., Thorpe, K. E., Roberts, R. S., Ellenbogen, K. A., Wilkoff, B. L., Morillo, C., Gent, M., & for the VPS II Investigators (2003) · JAMA · doi:10.1001/jama.289.17.2224 · Cited by 500
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Self-citationManagement of Vasovagal Syncope: Controlling or Aborting Faints by Leg Crossing and Muscle Tensing
Krediet, C. T. P., van Dijk, N., Linzer, M., van Lieshout, J. J., & Wieling, W. (2002) · Circulation · doi:10.1161/01.cir.0000030939.12646.8f · Cited by 372
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Risk Factors for Syncope Recurrence After a Positive Tilt-Table Test in Patients With Syncope
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Isometric arm counter-pressure maneuvers to abort impending vasovagal syncope
Brignole, M., Croci, F., Menozzi, C., Solano, A., Donateo, P., Oddone, D., Puggioni, E., & Lolli, G. (2002) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(02)02683-9 · Cited by 208
Self-citation
Research works printed but not linked: 1
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Sorted by citations
2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy
Authors Task Force Members, Brignole, M., Auricchio, A., Barón‐Esquivias, G., Bordachar, P., Boriani, G., Breithardt, O. A., Cleland, J. G. F., Deharo, J.-C., Delgado, V., et al. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht150 · Cited by 2,834
Self-citationDeveloped in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), societies, E. B. T. F., European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp298 · Cited by 2,040
Self-citation2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy
Glikson, M., Nielsen, J. C., Kronborg, M. B., Michowitz, Y., Auricchio, A., Barbash, I. M., Barrabés, J. A., Boriani, G., Braunschweig, F., Brignole, M., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab364 · Cited by 2,019
Self-citation2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya, A., de Lange, F. J., Deharo, J.-C., Elliott, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martín, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy037 · Cited by 1,951
“Cardiac pacing is not indicated in the absence of a documented cardioinhibitory reflex.(299,300) III B”
Self-citation2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy
Authors Task Force Members, Brignole, M., Auricchio, A., Barón‐Esquivias, G., Bordachar, P., Boriani, G., Breithardt, O. A., Cleland, J. G. F., Deharo, J., Delgado, V., et al. (2013) · EP Europace · doi:10.1093/europace/eut206 · Cited by 1,137
“The Second Vasovagal Pacemaker Study (VPS II) and the Vasovagal SYNcope and PACing trial (SYNPACE) gave totally different results.(22,23) The patients in these trials were younger (mean age: 50 years), had both cardio-inhibitory (mostly non-asystolic) and non-cardio-inhibitory responses during tilt test and patients i…”
ResultSelf-citationSheldon, R. S., Grubb, B. P., Olshansky, B., Shen, W.-K., Calkins, H., Brignole, M., Raj, S. R., Krahn, A. D., Morillo, C. A., Stewart, J. M., et al. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.03.029 · Cited by 1,013
Self-citation2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy
Glikson, M., Nielsen, J. C., Kronborg, M. B., Michowitz, Y., Auricchio, A., Barbash, I. M., Barrabés, J. A., Boriani, G., Braunschweig, F., Brignole, M., et al. (2021) · EP Europace · doi:10.1093/europace/euab232 · Cited by 936
Self-citationGuidelines for cardiac pacing and cardiac resynchronization therapy
Vardas, P. E., Auricchio, A., Blanc, J., Daubert, J., Drexler, H., Ector, H., Gasparini, M., Linde, C. M., Morgado, F. B., Oto, A., et al. (2007) · European Heart Journal · doi:10.1093/eurheartj/ehm305 · Cited by 895
Self-citation2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.03.004 · Cited by 478
“In 2 RCTs, there was no statistically significant benefit seen with active pacing (407,408).”
Background2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya‐Mitjans, À., de Lange, F. J., Deharo, J., Elliot, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martiın, A., et al. (2018) · Kardiologia Polska · doi:10.5603/kp.2018.0161 · Cited by 475
Self-citationBrignole, M., Menozzi, C., Moya, A., Andresen, D., Blanc, J. J., Krahn, A. D., Wieling, W., Beiras, X., Deharo, J. C., Russo, V., et al. (2012) · Circulation · doi:10.1161/circulationaha.111.082313 · Cited by 437
Self-citationShen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000499 · Cited by 463
“2004 15451153 (264) Aim: if pacing reduces syncope recurrence”
BackgroundShen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000498 · Cited by 411
Brignole, M., Sutton, R., Menozzi, C., Garcia-Civera, R., Moya, A., Wieling, W., Andresen, D., Benditt, D. G., & Vardas, P. (2006) · European Heart Journal · doi:10.1093/eurheartj/ehi842 · Cited by 376
Self-citation2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.03.003 · Cited by 327
Guidelines for cardiac pacing and cardiac resynchronization therapy
Vardas, P. E., Auricchio, A., Blanc, J., Daubert, J., Drexler, H., Ector, H., Gasparini, M., Linde, C. M., Morgado, F. B., Oto, A., et al. (2007) · EP Europace · doi:10.1093/europace/eum189 · Cited by 290
Self-citationGuía de práctica clínica para el diagnóstico y manejo del síncope (versión 2009)
Moya‐Mitjans, À., Sutton, R., Ammirati, F., Blanc, J., Brignole, M., Dahm, J. B., Deharo, J., Gajek, J. J., Gjesdal, K., Krahn, A. D., et al. (2009) · Revista Española de Cardiología (English Edition) · doi:10.1016/s1885-5857(09)73541-8 · Cited by 277
Self-citationPachon M, J. C., Pachon M, E. I., Cunha Pachon, M. Z., Lobo, T. J., Pachon M, J. C., & Santillana P, T. G. (2011) · Europace · doi:10.1093/europace/eur163 · Cited by 230
Neurocardiogenic Syncope and Related Disorders of Orthostatic Intolerance
Grubb, B. P. (2005) · Circulation · doi:10.1161/circulationaha.104.482018 · Cited by 210
JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias
Nogami, A., Kurita, T., Abe, H., Andò, K., Ishikawa, T., Imai, K., Usui, A., Okishige, K., Kusano, K., Kumagai, K., et al. (2021) · Circulation Journal · doi:10.1253/circj.cj-20-0637 · Cited by 205
2013 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy
Brignole, M., Auricchio, A., Barón‐Esquivias, G., Bordachar, P., Boriani, G., Breithardt, O. A., Cleland, J. G. F., Deharo, J.-C., Delgado, V., Elliott, P. M., et al. (2014) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2013.11.003 · Cited by 201
“Исследования VPS II (Second Vasovagal Pacemaker Study — Второе исследование электростимуляции при вазовагальном синдроме) и SYNPACE (Vasovagal SYNcope and PACing trial — исследование вазовагальных синкопальных состояний и электростимуляции) дали совершенно другие результаты [22, 23].”
Self-citationParoxysmal atrioventricular block
Lee, S., Wellens, H. J. J., & Josephson, M. E. (2009) · Heart Rhythm · doi:10.1016/j.hrthm.2009.04.001 · Cited by 164
JCS/JHRS 2019 guideline on non‐pharmacotherapy of cardiac arrhythmias
Nogami, A., Kurita, T., Abe, H., Andò, K., Ishikawa, T., Imai, K., Usui, A., Okishige, K., Kusano, K., Kumagai, K., et al. (2021) · Journal of Arrhythmia · doi:10.1002/joa3.12491 · Cited by 166
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.03.002 · Cited by 155
“, and H eart Rhythm Society 40 IIb B-R SR Dual-chamber pacing might be reasonable in a select population of patients 40 years of age or older with recurrent VVS and prolonged spontaneous pauses (404-408,410).”
BackgroundThe expectation effect and cardiac pacing for refractory vasovagal syncope
Sud, S., Massel, D., Klein, G. J., Leong-Sit, P., Yee, R., Skanes, A. C., Gula, L. J., & Krahn, A. D. (2007) · The American Journal of Medicine · doi:10.1016/j.amjmed.2006.05.046 · Cited by 151
Brignole, M. (2006) · European Heart Journal · doi:10.1093/eurheartj/ehl164 · Cited by 145
Self-citationESC Guidelines on cardiac pacing and cardiac resynchronization therapy
Nielsen, J. C., Petersen, H. H., Karlsen, F. M., Chri, L. S., & Haarbo, J. (2014) · Cited by 146
Yao, Y., Shi, R., Wong, T., Zheng, L., Chen, W., Yang, L., Huang, W., Bao, J., & Zhang, S. (2012) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.111.966465 · Cited by 155
“5 (3-100) Number of syncope in preceding 12 months, median (range) 3.”
BackgroundSun, W., Zheng, L., Yu, Q., Shi, R., Hou, B., Wu, L., Guo, J., Zhang, S., & Yao, Y. (2016) · Journal of the American Heart Association · doi:10.1161/jaha.116.003471 · Cited by 133
Cardiac pacing: the state of the art
Trohman, R. G., Kim, M. H., & Pinski, S. L. (2004) · The Lancet · doi:10.1016/s0140-6736(04)17358-3 · Cited by 133
Dual-Chamber Pacing With Closed Loop Stimulation in Recurrent Reflex Vasovagal Syncope
Barón‐Esquivias, G., Morillo, C. A., Moya‐Mitjans, À., Martínez-Alday, J. D., Ruiz‐Granell, R., Lacunza, J., García–Civera, R., Gutiérrez‐Carretero, E., & Romero-Garrido, R. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.08.026 · Cited by 131
“Our trial did not directly compare DDD-CLS pacing mode with other dualchamber pacing modes (DDI with hysteresis, DDD with rate drop response, and so on) that have had limited success in preventing recurrence of VVS (4,5).”
BackgroundMethodEvaluating and managing bradycardia
Sidhu, S., & Marine, J. E. (2020) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2019.07.001 · Cited by 134
Brignole, M., Donateo, P., Tomaino, M., Massa, R., Iori, M., Beiras, X., Moya, A., Kus, T., Deharo, J. C., Giuli, S., et al. (2014) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.113.001103 · Cited by 127
Self-citationPathophysiology, Diagnosis, and Treatment of Orthostatic Hypotension and Vasovagal Syncope
Medow, M. S., Stewart, J. M., Sanyal, S., Mumtaz, A., Sica, D. A., & Frishman, W. H. (2007) · Cardiology in Review · doi:10.1097/crd.0b013e31815c8032 · Cited by 114
“However, more recent trials such as the Second Vasovagal Pacemaker Study (VPSII) and the Vasovagal Syncope and Pacing Trial were not able to reproduce those results, suggesting that pacemaker therapy should not be recommended as first-line treatment for patients with recurrent vasovagal syncope.(187,188) Alternatively…”
ResultAn Implantable Loop Recorder Study of Highly Symptomatic Vasovagal Patients
Deharo, J.-C., Jego, C., Lanteaume, A., & Djiane, P. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.09.043 · Cited by 110
“This observation might be part of n explanation for the results of two recently published andomized studies on pacing therapy in vasovagal patients: n both studies, pacing therapy failed to show effectiveness, ven in the subgroup of patients presenting with severe radycardia at HUT (8,9).”
ResultHRS/ACCF Expert Consensus Statement on Pacemaker Device and Mode Selection
Gillis, A. M., Russo, A. M., Ellenbogen, K. A., Swerdlow, C. D., Olshansky, B., Al‐Khatib, S. M., Beshai, J. F., McComb, J. M., Nielsen, J. C., Philpott, J. M., et al. (2012) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2012.06.011 · Cited by 100
2013 ESC GUIDELINES ON CARDIAC PACING AND CARDIAC RESYNCHRONIZATION THERAPY
Brignole, M., Auricchio, A., Barón‐Esquivias, G., Bordachar, P., Boriani, G., Breithardt, O. A., Cleland, J. G. F., Deharo, J., Delgado, V., Elliot, P. M., et al. (2014) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2014-4-5-63 · Cited by 93
Self-citationCarotid sinus syndrome, should we pace? A multicentre, randomised control trial (Safepace 2)
Ryan, D. J., Nick, S., Colette, S. M., & Roseanne, K. (2010) · Heart · doi:10.1136/hrt.2009.176206 · Cited by 91
“SYNPACE, too has demonstrated similar findings to VPS2.(23)”
ResultInfluentialVasovagal Syncope in the Older Patient
Tan, M. P., & Parry, S. W. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.11.025 · Cited by 92
Saklani, P., Krahn, A. D., & Klein, G. J. (2013) · Circulation · doi:10.1161/circulationaha.112.138396 · Cited by 91
“The VPSII and SYNPACE trials were the first double blind randomized, controlled trials of permanent pacing in neurally mediated syncope designed to address these limitations.(102,103) All patients received pacemakers, and the control arm devices were functionally programmed off.”
ACC/AHA/HRS Versus ESC Guidelines for the Diagnosis and Management of Syncope
Goldberger, Z. D., Petek, B. J., Brignole, M., Shen, W.-K., Sheldon, R. S., Solbiati, M., Deharo, J.-C., Moya, A., & Hamdan, M. H. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.09.012 · Cited by 82
Self-citationPersistence of muscle sympathetic nerve activity during vasovagal syncope
Vaddadi, G., Esler, M. D., Dawood, T., & Lambert, E. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq071 · Cited by 84
Santini, M., Castro, A., Giada, F., Ricci, R., Inama, G., Gaggioli, G., Calò, L., Orazi, S., Viscusi, M., Chiodi, L., et al. (2013) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.112.975102 · Cited by 84
“possible placebo effect of pacing, as hypothesized in previous studies.(33) However, it should be noted that the study was not powered to evaluate individual end point events separately.”
ResultSelf-citationSUMNER, G. L., ROSE, M. S., KOSHMAN, M. L., RITCHIE, D., SHELDON, R. S., & for the Prevention of Syncope Trial Investigators (2010) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2010.01848.x · Cited by 80
Brignole, M., Ammirati, F., Arabia, F., Quartieri, F., Tomaino, M., Ungar, A., Lunati, M., Russo, V., Del Rosso, A., & Gaggioli, G. (2015) · European Heart Journal · doi:10.1093/eurheartj/ehv069 · Cited by 80
Self-citationRaj, S. R., Rose, S., Ritchie, D., & Sheldon, R. S. (2006) · American Heart Journal · doi:10.1016/j.ahj.2006.03.013 · Cited by 78
Diagnosis and treatment of syncope
Brignole, M. (2006) · Heart · doi:10.1136/hrt.2005.080713 · Cited by 77
Self-citationThe treatment of ictal asystole with cardiac pacing
Moseley, B. D., Ghearing, G. R., Munger, T. M., & Britton, J. W. (2011) · Epilepsia · doi:10.1111/j.1528-1167.2010.02972.x · Cited by 77
“However, other studies of vasovagal syncope patients and dual-chamber pacing have failed to reproduce such findings (Connolly et al., 2003; Raviele et al., 2004).”
ResultImplications of mechanism of bradycardia on response to pacing in patients with unexplained syncope
Sud, S., Klein, G. J., Skanes, A. C., Gula, L. J., Yee, R., & Krahn, A. D. (2007) · EP Europace · doi:10.1093/europace/eum020 · Cited by 66
“In previous studies of neurally-mediated syncope, patients with cardioinhibitory vasovagal syncope were identified by history and response to tilt table testing.(18,19,21,23) Response to tilt table testing may not reflect the physiological events that occur during a spontaneous episode.”
BackgroundHRS/ACCF Expert Consensus Statement on Pacemaker Device and Mode Selection
Gillis, A. M., Russo, A. M., Ellenbogen, K. A., Swerdlow, C. D., Olshansky, B., Al‐Khatib, S. M., Beshai, J. F., McComb, J. M., Nielsen, J. C., Philpott, J. M., et al. (2012) · Heart Rhythm · doi:10.1016/j.hrthm.2012.06.026 · Cited by 66
Palmisano, P., Dell’Era, G., Russo, V., Zaccaria, M., Mangia, R., Bortnik, M., Vecchi, F. D., Giubertoni, A., Patti, F., Magnani, A., et al. (2017) · EP Europace · doi:10.1093/europace/eux015 · Cited by 66
The Steering Committee of the ISSUE 3 Study (2007) · EP Europace · doi:10.1093/europace/eul135 · Cited by 65
Palmisano, P., Zaccaria, M., Luzzi, G., Nacci, F., Anaclerio, M., & Favale, S. (2012) · EP Europace · doi:10.1093/europace/eur419 · Cited by 63
“These suboptimal results are probably justified by the inability of conventional electrical cardiac stimulation to counteract the vasodepressor component of the vasovagal reflex present in almost all subjects during syncopal episodes and usually precedes cardioinhibition and bradycardia.(29)”
BackgroundManagement and therapy of vasovagal syncope: A review
Aydin, M. A. (2010) · World Journal of Cardiology · doi:10.4330/wjc.v2.i10.308 · Cited by 63
Aksu, T., Güler, T. E., Bozyel, S., Yalın, K., & Gopinathannair, R. (2020) · EP Europace · doi:10.1093/europace/euaa230 · Cited by 59
Tan, M. P., Newton, J. L., Chadwick, T. J., Gray, J. C., Nath, S., & Parry, S. W. (2010) · Europace · doi:10.1093/europace/eup368 · Cited by 58
Benditt, D. G., & Nguyen, J. T. (2009) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2008.12.065 · Cited by 55
High Remission Rates in Vasovagal Syncope
Pournazari, P., Sahota, I. S., & Sheldon, R. S. (2016) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2016.10.012 · Cited by 53
Calò, L., Rebecchi, M., Sette, A., Sciarra, L., Borrelli, A., Scarà, A., Grieco, D., Politano, A., Sgueglia, M., Luca, L. D., et al. (2020) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-020-00840-9 · Cited by 52
Selecting and measuring optimal outcomes for randomised controlled trials in surgery
Macefield, R. C., Boulind, C. E., & Blazeby, J. M. (2013) · Langenbeck s Archives of Surgery · doi:10.1007/s00423-013-1136-8 · Cited by 51
Syncope: Diagnosis and Management
Walsh, K., Hoffmayer, K. S., & Hamdan, M. H. (2014) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2014.11.001 · Cited by 51
Likelihood of injury due to vasovagal syncope: a systematic review and meta-analysis
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Evidence-based treatment for vasovagal syncope
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New insights in diagnostics and therapies in syncope: a novel approach to non-cardiac syncope
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Self-citationNorepinephrine transporter inhibition prevents tilt-induced pre-syncope
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“When studies comparing optimal pacer therapy were compared to other pacing [47,49,52], again a significant benefit was observed (three studies, n=92, OR 0.”
BackgroundMethodResultClinical Classification of Syncope
Sutton, R. (2013) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2012.11.005 · Cited by 41
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“However, previous atropine and cardiac pacing studies have yielded conflicting results, indicating that bradycardia may not always be the only factor in restricting cardiac output (Weissler et al., 1957; Fujimura et al., 1989; Sra et al., 1993; Connolly et al., 1999; Sutton et al., 2000; Ammirati et al., 2001; Connoll…”
ResultMoya, A., Brignole, M., Sutton, R., Menozzi, C., Garcia-Civera, R., Wieling, W., Andresen, D., Benditt, D. G., Garcia-Sacristán, J. F., Beiras, X., et al. (2008) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2008.07.043 · Cited by 38
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“Indeed, prevention of bradycardia and asystole with cardiac pacemakers was largely ineffective [9,10] and is only recommended when severe spontaneous bradycardia is detected during prolonged EKG monitoring, but not on tilt test results alone [11].”
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“In 2 RCTs, there was no statistically significant benefit seen with active pacing.(407,408) However, in a select population of patients .”
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Key challenges in the current management of syncope
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Self-citationGopinathannair, R., Salgado, B. C., & Olshansky, B. (2018) · Arrhythmia & Electrophysiology Review · doi:10.15420/aer.2018.22.2 · Cited by 33
“The RRR in time to syncope with DDD was 30 % (95 % CI [−33–63 %]; 1-sided p=0.14) Raviele et al., 2004 (SYNPACE Study)49 Randomised, double-blind, placebo-controlled; DDD with RDR comparison of PPM on versus off Severe recurrent tilt-induced vasovagal syncope (median 12 syncopal episodes in…”
BackgroundInfluentialTilt Training: Does It Have a Role in Preventing Vasovagal Syncope?
Gurevitz, O. T., Barsheshet, A., Bar-Lev, D. S., Zimlichman, E., Rosenfeld, G., Benderly, M., Luria, D. M., Amital, H., Kreiss, Y., Eldar, M., et al. (2007) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2007.00898.x · Cited by 33
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Placebo Control and Blinding in Randomized Trials of Procedural Interventions
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“Four trials assessed coprimary outcomes.(16,21,22,36) In 10 trials (33%), the null hypotheses were rejected for all predefined primary outcomes.”
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Guía ESC 2021 sobre estimulación cardiaca y terapia de resincronización
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Self-citationProtecting human subjects in brain research: a pragmatic perspective
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Metadata
- Authors
- RAVIELE, A., GIADA, F., MENOZZI, C., SPECA, G., ORAZI, S., GASPARINI, G., SUTTON, R., & BRIGNOLE, M.
- Affiliations
- Santa Maria Nuova Hospital (IT)
- Royal Brompton Hospital (GB)
- Corresponding author
- RAVIELE, A
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2004-10
- Volume
- 25
- Issue
- 19
- Pages
- 1741-1748
- ISSN
- 0195-668X (ISSN-L)
- OpenAlex
- W1982517883
- Semantic Scholar
- fc5273c9844e2031f629c06b5ca6a054616c5cd2
- Cited by
- 323
- References
- 28
- Citations by year
- 2026: 7 · 2025: 4 · 2024: 3 · 2023: 2 · 2022: 5 · 2021: 17 · 2020: 15 · 2019: 13 · 2018: 12 · 2017: 23 · 2016: 16 · 2015: 12 · 2014: 23 · 2013: 21 · 2012: 17
- FWCI
- 17.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, other-oa)
- Zenodo (CERN European Organization for Nuclear Research) (other-oa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- vasovagal syncope, permanent cardiac pacing, pacemaker implantation, syncope recurrence, head-up tilt
- MeSH terms
- Cardiac Pacing, Artificial, Double-Blind Method, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pacemaker, Artificial, Prospective Studies, Treatment Outcome, Tilt-Table Test, Syncope, Vasovagal, Secondary Prevention
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