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Cited by 35Cardiovascular Syncope and Autonomic DisordersCardiac pacing and defibrillation studiesCardiac electrophysiology and arrhythmias

Syncope in patients paced for atrioventricular block

Aste, Milena, Oddone, Daniele, Donateo, Paolo, Solano, Alberto, Maggi, Roberto, Croci, Francesco, Solari, Diana, Brignole, Michele·2016·Europace
DOI 10.1093/europace/euv425
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Abstract

AIMS: Although syncope is the main reason for cardiac pacing in ∼40% of patients affected by atrioventricular block (AVB), very few data are available on the benefit of cardiac pacing in preventing syncopal recurrences. METHODS AND RESULTS: We retrospectively evaluated 229 consecutive patients (124 males, age 80 ± 10 years) who had received a permanent pacemaker from January 2009 to December 2013 for AVB and syncope (94 patients, 41%) or AVB without syncope (135 patients, 59%). In patients with AVB and syncope, a third-degree or Mobitz II second-degree AVB had been documented in 73 and was only suspected in another 21, all of whom had bundle branch block. Follow-up was available in 223 patients. At 5 years, the actuarial syncope recurrence rate was 1% (95% CI, 0-3) in patients with documented AVB plus syncope and 3% (95% CI, 1-5) in those without syncope, whereas it was 14% (95% CI, 0-28) in patients with undocumented AVB plus syncope (P = 0.001). The actuarial combined recurrence rate of syncope and/or pre-syncope was 2% (95% CI, 0-4) in patients without syncope, 8% (95% CI, 0-17) in patients with documented AVB plus syncope, and 19% (95% CI, 1-37) in patients with undocumented AVB plus syncope, P = 0.002. All syncopes occurred in patients without overt structural heart disease (SHD), the corresponding actuarial estimate being 4% (95% CI, 0-6) at 1 year and 6% (95% CI, 4-8) at 5 years (P = 0.002 vs. patients with SHD). CONCLUSIONS: Cardiac pacing is highly effective in preventing syncopal recurrences when AVB is documented. Syncope may recur in a non-negligible minority of paced patients when AVB is suspected but not documented and in patients without SHD.

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Crossref · 10.1093/europace/euv425

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  • Tachycardia-related exercise-induced second- and third-degree AV block predicts progression to permanent AV block.

    “and predicts progression to permanent AV block. 254,255”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [255]

  • Some observational studies suggest that pacing is highly effective in preventing syncope recurrences when AV block is documented.

    “Although formal RCTs of pacing in thirdor second-degree type 2 AV block have not been performed, some observational studies suggest that pacing is highly effective in preventing syncope recurrences when AV block is documented.”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [255]

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Authors
Aste, M., Oddone, D., Donateo, P., Solano, A., Maggi, R., Croci, F., Solari, D., & Brignole, M.
Affiliations
Presidio Ospedaliero (IT)
Corresponding author
Brignole, Michele
ORCID
Venue
Europace
Publisher
Oxford University Press (OUP)
Published
2016-02-06
Volume
18
Issue
11
Pages
1735-1739
ISSN
  • 1099-5129 (ISSN-L)
  • 1532-2092
DOI
10.1093/europace/euv425
OpenAlex
W2259183498
Cited by
35
References
19
Citations by year
2026: 1 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 3 · 2020: 5 · 2019: 6 · 2018: 9 · 2017: 4 · 2016: 1
FWCI
7.38
Type
journal article
Language
en
Open access
closed
Locations
  • EP Europace (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords
syncope, atrioventricular block, cardiac pacing, permanent pacemaker, syncope recurrence, presyncope, complete heart block, bundle branch block, structural heart disease, pacemaker indications
MeSH terms
Aged, Aged, 80 and over, Bundle-Branch Block, Cardiac Pacing, Artificial, Female, Humans, Italy, Male, Pacemaker, Artificial, Recurrence, Retrospective Studies, Syncope, Atrioventricular Block

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