The DOI matches its Crossref record; 26 of the 26 references it cites were found in a registry or an index.
Assessment of a standardized algorithm for cardiac pacing in older patients affected by severe unpredictable reflex syncopes
Open accessAbstract
AIMS: Opinions differ regarding the effectiveness of cardiac pacing in patients affected by reflex syncope. We assessed a standardized guideline-based algorithm in different forms of reflex syncope. METHODS AND RESULTS: In this prospective, multi-centre, observational study, patients aged >40 years, affected by severe unpredictable recurrent reflex syncopes, 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. POPULATION: 253 patients, mean age 70 ± 12 years, median 4 (3-6) syncopes, 89% without or with short prodromes. Of these patients, 120 (47%) received a pacemaker and 106 were followed up for a mean of 13 ± 7 months: syncope recurred in 10 (9%). The recurrence rate was similar in 61 CSM+ (11%), 30 TT+ (7%), and 15 ILR+ (7%) patients. The actuarial total syncope recurrence rate was 9% (95% confidence interval (CI), 6-12) at 1 year and 15% (95% CI, 10-20) at 2 years and was significantly lower than that observed in the group of 124 patients with non-diagnostic tests who had received an ILR: i.e. 22% (95% CI, 18-26) at 1 year and 37% (95% CI, 30-43) at 2 years (P = 0.004). CONCLUSION: About half of older patients with severe recurrent syncopes without prodromes have an asystolic reflex for which cardiac pacing goes along with a low recurrence rate. The study supports the clinical utility of the algorithm for the selection of candidates to cardiac pacing in everyday clinical practice. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01509534.
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“Most evidence in support of the above diagnostic criteria is indirectly based on the benefit of specific therapies guided by ECG monitoring in preventing syncopal recurrences. 172,184-186,188,200”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [186]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Even if the quality of evidence is moderate, there is strong consensus based on evidence from several controlled trials that a correlation between symptoms and a documented arrhythmia, or the presence of some asymptomatic significant arrhythmias (defined above), is diagnostic of the cause of syncope and specific treatment must be prescribed.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [186]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Similar findings were subsequently observed with ILR use expanded in an early phase of evaluation in patients with recurrent syncope of uncertain origin, in the absence of highrisk criteria and structural heart disease, 176,180-183 and in suspected reflex syncope. 184-186 In particular, an asystolic pause was present during syncope in about 50% of these patients.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [186]
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“Only 14% of the highly selected population with reflex syncope who are referred to specialized syncope units may need such additional treatment. 186”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [186]
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“The algorithm shown in Figure 11 has recently been prospectively validated in a multicentre pragmatic study, which showed a low recurrence rate of syncope with pacing of 9% at 1 year and 15% at 2 years, significantly lower than the 22% and 37%, respectively, observed in unpaced controls. 186”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [186]
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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-citationA pragmatic–explanatory continuum indicator summary (PRECIS): a tool to help trial designers
Thorpe, K. E., Zwarenstein, M., Oxman, A. D., Treweek, S., Furberg, C. D., Altman, D. G., Tunis, S., Bergel, E., Harvey, I., Magid, D. J., et al. (2009) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2008.12.011 · Cited by 1,389
Brignole, M. (2000) · Europace · doi:10.1053/eupc.1999.0064 · Cited by 451
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-citationA pragmatic-explanatory continuum indicator summary (PRECIS): a tool to help trial designers
Thorpe, K. E., Zwarenstein, M., Oxman, A., Treweek, S. P., Furberg, C. D., Altman, D. G., Tunis, S., Bergel, E. F., Harvey, I. M., Magid, D. J., et al. (2009) · Canadian Medical Association Journal · doi:10.1503/cmaj.090523 · Cited by 428
Sutton, R., Brignole, M., Menozzi, C., Raviele, A., Alboni, P., Giani, P., & Moya, A. (2000) · Circulation · doi:10.1161/01.cir.102.3.294 · Cited by 407
Self-citationBrignole, 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-citationIndications for the use of diagnostic implantable and external ECG loop recorders
Task Force members, Brignole, M., Vardas, P., Hoffman, E., Huikuri, H., Moya, A., Ricci, R., Sulke, N., Wieling, W., EHRA Scientific Documents Committee, et al. (2009) · Europace · doi:10.1093/europace/eup097 · Cited by 362
Self-citationBrignole, M., Menozzi, C., Bartoletti, A., Giada, F., Lagi, A., Ungar, A., Ponassi, I., Mussi, C., Maggi, R., Re, G., et al. (2006) · European Heart Journal · doi:10.1093/eurheartj/ehi647 · Cited by 332
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2021 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
Self-citationBrignole, M., Arabia, F., Ammirati, F., Tomaino, M., Quartieri, F., Rafanelli, M., Del Rosso, A., Rita Vecchi, M., Russo, V., & Gaggioli, G. (2016) · Europace · doi:10.1093/europace/euv343 · Cited by 76
Self-citationStop vasodepressor drugs in reflex syncope: a randomised controlled trial
Solari, D., Tesi, F., Unterhuber, M., Gaggioli, G., Ungar, A., Tomaino, M., & Brignole, M. (2017) · Heart · doi:10.1136/heartjnl-2016-309865 · Cited by 68
Self-citationSyncope in patients paced for atrioventricular block
Aste, M., Oddone, D., Donateo, P., Solano, A., Maggi, R., Croci, F., Solari, D., & Brignole, M. (2016) · Europace · doi:10.1093/europace/euv425 · Cited by 35
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Metadata
- Authors
- Brignole, M., Ammirati, F., Arabia, F., Quartieri, F., Tomaino, M., Ungar, A., Lunati, M., Russo, V., Del Rosso, A., & Gaggioli, G.
- Affiliations
- Presidio Ospedaliero (IT)
- Azienda Ospedaliera Pugliese Ciaccio (IT)
- Santa Maria Nuova Hospital (IT)
- Ospedale di Bolzano (IT)
- Azienda Ospedaliero-Universitaria Careggi (IT)
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
- Ospedale Villa Scassi (IT)
- Corresponding author
- Brignole, Michele
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-03-29
- Volume
- 36
- Issue
- 24
- Pages
- 1529-1535
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2174864566
- Cited by
- 80
- References
- 26
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 5 · 2023: 2 · 2022: 9 · 2021: 7 · 2020: 8 · 2019: 9 · 2018: 10 · 2017: 8 · 2016: 12 · 2015: 4
- FWCI
- 11.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Florence Research (University of Florence) (submittedVersion, 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
- reflex syncope, cardiac pacing, dual-chamber pacemaker, elderly patients, carotid sinus massage, tilt table test, implantable loop recorder, syncope recurrence, diagnostic algorithm
- MeSH terms
- Aged, Algorithms, Cardiac Pacing, Artificial, Female, Humans, Male, Massage, Prospective Studies, Syncope, Electrocardiography, Ambulatory, Treatment Outcome, Tilt-Table Test, Secondary Prevention
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