Department of Emergency and Organ Transplantation, Cardiology Unit, University of Bari, Pietro Palmisano, Piazza Giulio Cesare 11, 70124 Bari, Italy.
Europace. 2012 Jul;14(7):1038-43. doi: 10.1093/europace/eur419. Epub 2012 Jan 13.
Closed-loop stimulation (CLS) pacing has shown greater efficacy in preventing the recurrence of vasovagal syncope (VVS) in patients with a cardioinhibitory response to head-up tilt test (HUTT) compared with conventional pacing. Moreover, there is no conclusive evidence to support the superiority of CLS over the conventional algorithms for syncope prevention. This study retrospectively evaluated the effectiveness of CLS pacing compared with dual-chamber pacing with conventional specialized sensing and pacing algorithms for syncope prevention in the prevention of syncope recurrence in patients with refractory VVS and a cardioinhibitory response to HUTT during a long-term follow-up.
Forty-one patients (44% male, 53 ± 16 years) with recurrent, refractory VVS (26% with trauma) and a cardioinhibitory response to HUTT who had undergone pacemaker implantation were included in the analysis. Twenty-five patients received a dual-chamber CLS pacemaker (CLS group) and 16 patients received a dual-chamber pacemaker with conventional algorithms for syncope prevention (conventional pacing group): 9 patients with Medtronic rate drop response algorithm and 7 patients with Guidant-Boston Scientific sudden brady response algorithm. During the follow-up (mean 4.4 ± 3.0 years, interquartile range 2.2-7.4 years) one patient (4%) in the CLS group and six (38%) in the conventional pacing group had syncope recurrences (P= 0.016). The Kaplan-Meier actuarial estimate of first recurrence of syncope after 8 years was 4% in the CLS group and 40% in the conventional pacing group (P= 0.010).
The results of this retrospective analysis show that, in order to prevent a recurrence of VVS in patients with a cardioinhibitory response to HUTT, dual-chamber CLS pacing was more effective than dual-chamber pacing with conventional algorithms for syncope prevention in preventing bradycardia-related syncope.
与传统起搏相比，闭环刺激（CLS）起搏在预防因头高位倾斜试验（HUTT）出现心脏抑制反应的血管迷走性晕厥（VVS）患者晕厥复发方面显示出更大的疗效。此外，尚无确凿证据支持 CLS 优于常规算法在预防晕厥方面的优越性。本研究回顾性评估了 CLS 起搏与具有传统专门感知和起搏算法的双腔起搏在预防心脏抑制反应的难治性 VVS 患者晕厥复发方面的有效性，在长期随访中预防晕厥复发。
分析了 41 例（44%为男性，53 ± 16 岁）因难治性 VVS （26%有创伤史）且因 HUTT 出现心脏抑制反应而接受起搏器植入的患者。25 例患者接受双腔 CLS 起搏器（CLS 组），16 例患者接受具有预防晕厥常规算法的双腔起搏器（传统起搏组）：9 例采用美敦力率下降反应算法，7 例采用 Guidant-Boston Scientific 突发心动过缓反应算法。在随访期间（平均 4.4 ± 3.0 年，四分位间距 2.2-7.4 年），CLS 组中有 1 例（4%）患者和传统起搏组中有 6 例（38%）患者发生晕厥复发（P=0.016）。8 年后，CLS 组首次晕厥复发的 Kaplan-Meier 估计生存率为 4%，而传统起搏组为 40%（P=0.010）。
这项回顾性分析的结果表明，为了预防因 HUTT 出现心脏抑制反应的 VVS 患者晕厥复发，与具有预防晕厥常规算法的双腔起搏相比，双腔 CLS 起搏在预防与心动过缓相关的晕厥方面更有效。
