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Cited by 85Cardiovascular Syncope and Autonomic DisordersCardiac pacing and defibrillation studiesCardiac electrophysiology and arrhythmias

Prevention of Syncope Through Permanent Cardiac Pacing in Patients With Bifascicular Block and Syncope of Unexplained Origin: The PRESS Study

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Santini, Massimo, Castro, Antonio, Giada, Franco, Ricci, Renato, Inama, Giuseppe, Gaggioli, Germano, Calò, Leonardo, Orazi, Serafino +12 more·2013·Circulation: Arrhythmia and Electrophysiology
DOI 10.1161/circep.112.975102
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Abstract

BACKGROUND: Syncope in patients with bifascicular block (BFB) is a common event whose causes might be difficult to assess. METHODS AND RESULTS: Prevention of syncope through permanent cardiac pacing in patients with bifascicular block (PRESS) is a multicenter, prospective, randomized, single-blinded study designed to demonstrate a reduction in symptomatic events in patients with bifascicular block and syncope of undetermined origin implanted with permanent pacemaker. Device programming mode (NASPE/BPEG code) at DDD with a lower rate of 60 ppm is compared with backup pacing at DDI with a lower rate of 30 ppm. The end point consisted of (1) syncope, (2) symptomatic presyncopal episodes associated with a device intervention (ventricular pacing), and (3) symptomatic episodes associated with intermittent or permanent atrioventricular block (any degree). One hundred one patients were enrolled and randomized. Primary end point events at 2 years were observed in 23 patients, with a significant lower incidence in the study group (hazard ratio, 0.32; 95% confidence interval [CI], 0.10-0.96; P=0.042). Reduction of any symptoms, associated or not with device intervention, was superior in DDD60 compared with DDI30 (hazard ratio, 0.4; 95% confidence interval, 0.25-0.78; P=0.0053). Fourteen patients developed other rhythm diseases and met class I indication for pacing. The annual incidence of rhythm disease development was 7.4%. CONCLUSIONS: In patients with bifascicular block and syncope of undetermined origin, the use of a dual chamber pacemaker programmed to DDD60 led to a significant reduction of syncope or symptomatic events associated with a cardioinhibitory origin, compared with DDI30 programming. Symptoms associated with a new onset of rhythm disease were found in 15% of the population at 2 years.

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Crossref · 10.1161/circep.112.975102

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  • Implantation of a pacemaker without documentation of AV block (empirical pacing) exposed patients to the risk of recurrence of syncope in about one-quarter of cases during long-term follow-up and was unnecessary in another half.

    “Conversely, implantation of a pacemaker without documentation of AV block (empirical pacing) exposed patients to the risk of recurrence of syncope in about one-quarter of cases during long-term follow-up and was unnecessary in another half. 217,344”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [344]

    The Methods and Discussion describe pacemaker implantation without documented AV block, and the Results report syncope despite pacing. But over two years, syncope occurred in 7 of 52 actively paced patients (13.5%), not about one-quarter; the 25% figure includes presyncope. The paper does not establish that pacing was unnecessary in half of patients. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The PRESS trial showed that patients with bifascicular block and unexplained syncope randomized to active empiric dual-chamber pacing (DDD60) had a 68% reduction in a composite endpoint of syncope/presyncope, presyncope with device intervention, or symptomatic atrioventricular block, compared to minimal backup pacing (DDI30).

    “The PRESS trial reinforced this evidence, showing that patients with BFB and unexplained syncope randomized to active empiric dual-chamber pacing (DDD60) had a 68% reduction in a composite endpoint of syncope/presyncope, presyncope with device intervention, or symptomatic AVB, compared to minimal backup pacing (DDI30) [16].”

    From Empiric pacing in unexplained syncope and bifascicular block: A systematic review and meta-analysis (2026) · cites this paper as [16]

  • The inclusion of patients with suspected vasovagal syncope in SPRITELY introduces confounding, whereas the PRESS trial mitigated this by excluding such patients with tilt-table testing.

    “The inclusion of patients with suspected vasovagal syncope in SPRITELY introduces confounding, whereas the PRESS trial mitigated this by excluding such patients with tilt-table testing [16].”

    From Empiric pacing in unexplained syncope and bifascicular block: A systematic review and meta-analysis (2026) · cites this paper as [16]

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Research works printed but not linked: 2

  1. Scheinman MM, Peters RW, Suavé MJ, Desai J, Abbott JA, Cogan J, Wohl B, Williams K. Value of the H-Q interval in patients with bundle branch block and the role of prophylactic permanent pacing. Am J Cardiol. 1982;50:1316-1322.
  2. McAnulty JH, Rahimtoola SH, Murphy E, DeMots H, Ritzmann L, Kanarek PE, Kauffman S. Natural history of "high-risk" bundle- branch block: final report of a prospective study. N Engl J Med. 1982;307:137-143.

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Authors
Santini, M., Castro, A., Giada, F., Ricci, R., Inama, G., Gaggioli, G., Calò, L., Orazi, S., Viscusi, M., Chiodi, L., Bartoletti, A., Foglia-Manzillo, G., Ammirati, F., Loricchio, M. L., Pedrinazzi, C., Turreni, F., Gasparini, G., Accardi, F., Raciti, G., & Raviele, A.
Affiliations
Ospedale San Filippo Neri (IT)
ORCID
Venue
Circulation: Arrhythmia and Electrophysiology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2013-02
Volume
6
Issue
1
Pages
101-107
ISSN
  • 1941-3084 (ISSN-L)
  • 1941-3149
DOI
10.1161/circep.112.975102
OpenAlex
W2158134491
Cited by
84
References
35
Citations by year
2026: 4 · 2025: 2 · 2024: 4 · 2023: 7 · 2022: 14 · 2021: 6 · 2020: 8 · 2019: 5 · 2018: 15 · 2017: 7 · 2016: 3 · 2015: 2 · 2014: 4 · 2013: 3
FWCI
3.94
Type
journal article
Language
en
Open access
Locations
  • Circulation Arrhythmia and 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
syncope, bifascicular block, permanent cardiac pacing, dual-chamber pacemaker, DDD pacing, pacemaker programming, atrioventricular block, cardioinhibitory syncope, syncope prevention
MeSH terms
Aged, Aged, 80 and over, Cardiac Pacing, Artificial, Equipment Design, Female, Heart Block, Humans, Italy, Male, Pacemaker, Artificial, Prospective Studies, Syncope, Time Factors, Proportional Hazards Models, Single-Blind Method, Treatment Outcome, Kaplan-Meier Estimate

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