The effect of dual-chamber closed-loop stimulation on syncope recurrence in healthy patients with tilt-induced vasovagal cardioinhibitory syncope: a prospective, randomised, single-blind, crossover study
Abstract
BACKGROUND: The closed-loop stimulation (CLS) pacemaker algorithm is a system that permanently monitors the contractile state of the myocardium and converts the intrinsic information into rate regulation. The role that the CLS algorithm plays in the prevention of syncope recurrences still remains unclear. The aim of our prospective, randomised, single-blind, crossover study was to evaluate the effect of dual-chamber CLS in the prevention of syncope recurrence in patients with refractory vasovagal syncope (VVS) and a cardioinhibitory response to head-up tilt test (HUT) during a 36 months follow-up. METHOD SAND RESULTS: We studied 50 patients (mean age 53 ± 5.1; 33 male) with the indication for permanent dual-chamber cardiac pacing for HUT-induced vasovagal cardioinhibitory syncope. They were randomised after 1 month of stabilisation period to CLS algorithm features programmed OFF or ON for 18 months each, using a crossover design. The number of syncopal and presyncopal episodes during active treatment was lower than those registered during no treatment (n syncopal episodes: 2 vs 15; p=0.007; n presincopal episodes: 5 vs 30; p = 0.004). Lead parameters remained stable over time, and there were no lead-related complications. CONCLUSIONS: Based on these 36 months follow-up data, it is concluded that dual-chamber CLS is an effective algorithm for preventing syncope recurrences in healthy patients with tilt-induced vasovagal cardioinhibitory syncope.
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In patients with VVS, dual-chamber closed-loop stimulation resulted in fewer syncope recurrences than conventional dual-chamber pacing, both in the acute setting during repeated tilt testing and during 18-month clinical follow-up.
“A comparison between dual-chamber closed-loop stimulation and conventional dual-chamber pacing has been performed by means of a crossover design in two small studies; these studies showed fewer syncope recurrences with closed-loop stimulation, both in the acute setting during repeated tilt testing 307 and during 18-month clinical follow-up. 308”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [308]
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- Authors
- Russo, V., Rago, A., Papa, A. A., Golino, P., Calabrò, R., Russo, M. G., & Nigro, G.
- Affiliations
- University of Campania "Luigi Vanvitelli" (IT)
- Corresponding author
- Papa, Andrea Antonio
- ORCID
- Venue
- Heart
- Publisher
- BMJ
- Published
- 2013-05-30
- Volume
- 99
- Issue
- 21
- Pages
- 1609-1613
- ISSN
- 1355-6037 (ISSN-L)
- 1468-201X
- OpenAlex
- W2116401750
- Cited by
- 59
- References
- 24
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 1 · 2023: 4 · 2022: 3 · 2021: 5 · 2020: 7 · 2019: 6 · 2018: 7 · 2017: 11 · 2016: 3 · 2015: 2 · 2014: 3
- FWCI
- 2.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- 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 › Heart Rate Variability and Autonomic Control
- Keywords
- closed-loop stimulation, dual-chamber pacemaker, vasovagal syncope, cardioinhibitory syncope, head-up tilt, cardiac pacing, pacemaker algorithms
- MeSH terms
- Algorithms, Cardiac Pacing, Artificial, Female, Heart Rate, Humans, Italy, Male, Middle Aged, Myocardial Contraction, Posture, Prospective Studies, Recurrence, Time Factors, Single-Blind Method, Treatment Outcome, Cross-Over Studies, Tilt-Table Test, Syncope, Vasovagal
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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