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Cited by 59Cardiovascular Syncope and Autonomic DisordersCardiac pacing and defibrillation studiesCardiac electrophysiology and arrhythmias

Is DDD superior to VVI pacing in mixed carotid sinus syndrome? An acute and medium-term study

BRIGNOLE, MICHELE, SARTORE, BRUNO, BARRA, MAURO, MENOZZI, CARLO, LOLLI, GINO·1988·Pacing and Clinical Electrophysiology
DOI 10.1111/j.1540-8159.1988.tb06327.x
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Abstract

The aim of this study was to evaluate fhe importance of atrial synchronism for pacing therapy of patients with mixed carotid sinus syndrome. In 23 patients (21 m, two f: mean age 69 ± 8 years) affected by symptomatic mixed carotid sinus syndrome we performed: (1) Research of ventriculo‐atrial conduction, orthostatic hypotension and pacemaker effect; and [2] Carotid sinus massage in the standing position during VVI and DVI temporary pacing. Next, ail patients received a permanent DDD pacemaker and entered a 2 month two period single‐blind, randomized, cross‐over study on DVI/DDD versus VVI mode. During the DVI/DDD period, no syncope occurred in any patients, minor symptoms persisted in 11 (48%) of them; during VVI period syncopes recurred in three patients, symptoms requiring the withdrawal of VVI pacing and premature DVI/DDD reprogramming in eight patients, minor symptoms in 17 (74%). A comparison between 14 patients, who preferred DVI/DDD period (Group A), and the remaining nine patients who noted no preference between DVI/DDD and VVI period (Group B) was performed on the basis of the preimplant evaluation. Group A patients had a greater pacemaker effect (‐34 ± 16 mmHg vs ‐16 ± 14 mmHg) and a higher prevalence of symptomatic pacemaker effect (50% vs 0%), of ventriculo‐atrial conduction (78% vs 44%) and of orthostatic hypotension (50% vs 11%), while the entity of the systolic pressure fall caused by carotid sinus massage was similar in the two groups either during VVI mode (Group A‐51 ± 16 mmHg vs Group B‐56 ± 27 mmHg) or DVI mode (Group A‐38 ± 17 mmHg vs Group 3–45 ± 17 mmHg). Thus, we conclude that vasodepressor reflex of carotid sinus syndrome is not prevented by DVI/DDD pacing even if the loss of atrial synchronism resulting from WI pacing, by adding an important pacemaker effect, causes a more severe hemodynamic consequence. DVI/DDD pacing is more effective than VVI in 61% of patients. When pacemaker effect, ventriculoatrial conduction and orthostatic hypotension are present, VVI failure is possible, therefore DVI/DDD stimulation is indicated; on the contrary the evaluation of the vasodepressor reflex during WJ or DVI temporary pacing is of little value in the choice of the mode of pacing.

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  • In CSS, dual-chamber pacing is better than single-chamber ventricular mode in counteracting BP fall during CSM and in preventing symptom recurrences.

    “In CSS, a few small controlled studies 304,305 and one registry 306 showed that dual-chamber pacing is better than the single chamber ventricular mode in counteracting BP fall during CSM and in preventing symptom recurrences.”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [305]

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Authors
BRIGNOLE, M., SARTORE, B., BARRA, M., MENOZZI, C., & LOLLI, G.
Affiliations
Presidio Ospedaliero (IT)
Corresponding author
BRIGNOLE, MICHELE
ORCID
BRIGNOLE, MICHELE
Venue
Pacing and Clinical Electrophysiology
Publisher
Wiley
Published
1988-11
Volume
11
Issue
11
Pages
1902-1910
ISSN
  • 0147-8389 (ISSN-L)
  • 1540-8159
DOI
10.1111/j.1540-8159.1988.tb06327.x
OpenAlex
W2099773135
Cited by
59
References
9
Citations by year
2023: 1 · 2018: 4 · 2017: 6 · 2016: 1 · 2015: 1 · 2014: 6 · 2013: 4 · 2012: 2
FWCI
1.71
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 6450 d)
Locations
  • Pacing and Clinical Electrophysiology (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
DDD pacing, VVI pacing, orthostatic hypotension, carotid sinus massage, syncope, carotid sinus syndrome
MeSH terms
Aged, Cardiac Pacing, Artificial, Carotid Sinus, Clinical Trials as Topic, Female, Follow-Up Studies, Humans, Hypotension, Orthostatic, Male, Pacemaker, Artificial, Random Allocation, Reflex, Abnormal, Syncope, Syndrome

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