Giannopoulos Georgios, Kossyvakis Charalampos, Panagopoulou Vasiliki, Tsiachris Dimitrios, Doudoumis Konstantinos, Mavri Maria, Vrachatis Dimitrios, Letsas Konstantinos, Efremidis Michael, Katsivas Apostolos, Lekakis John, Deftereos Spyridon
Cardiology Department, Athens General Hospital "G. Gennimatas," Athens, Greece; 2nd Department of Cardiology, National and Kapodistrean University of Athens Medical School, Attikon University Hospital, Athens, Greece.
Cardiology Department, Athens General Hospital "G. Gennimatas," Athens, Greece.
Heart Rhythm. 2017 May;14(5):694-699. doi: 10.1016/j.hrthm.2017.01.012. Epub 2017 Jan 12.
Syncope is a common problem in the elderly, and a permanent pacemaker is a therapeutic option when a bradycardic etiology is revealed. However, the benefit of pacing when no association of symptoms to bradycardia has been shown is not clear, especially in the elderly.
The aim of this study was to evaluate the effect of pacing on syncope-free mortality in patients aged 80 years or older with unexplained syncope and "positive" invasive electrophysiologic testing (EPT).
This was an observational study. A positive EPT for the purposes of this study was defined by at least 1 of the following: a corrected sinus node recovery time of >525 ms, a basic HV interval of >55 ms, detection of infra-Hisian block, or appearance of second-degree atrioventricular block on atrial decremental pacing at a paced cycle length of >400 ms.
Among the 2435 screened patients, 228 eligible patients were identified, 145 of whom were implanted with a pacemaker. Kaplan-Meier analysis determined that time to event (syncope or death) was 50.1 months (95% confidence interval 45.4-54.8 months) with a pacemaker vs 37.8 months (95% confidence interval 31.3-44.4 months) without a pacemaker (log-rank test, P = .001). The 4-year time-dependent estimate of the rate of syncope was 12% vs 44% (P < .001) and that of any-cause death was 41% vs 56% (P = .023), respectively. The multivariable odds ratio was 0.25 (95% confidence interval 0.15-0.40) after adjustment for potential confounders.
In patients with unexplained syncope and signs of sinus node dysfunction or impaired atrioventricular conduction on invasive EPT, pacemaker implantation was independently associated with longer syncope-free survival. Significant differences were also shown in the individual components of the primary outcome measure (syncope and death from any cause).
晕厥在老年人中是一个常见问题，当发现存在心动过缓病因时，永久起搏器是一种治疗选择。然而，在未显示症状与心动过缓有关联时进行起搏治疗的益处尚不清楚，尤其是在老年人中。
本研究的目的是评估起搏治疗对80岁及以上不明原因晕厥且侵入性电生理检查（EPT）“阳性”患者无晕厥生存率的影响。
这是一项观察性研究。本研究中EPT阳性定义为符合以下至少一项：校正窦房结恢复时间>525毫秒、基础HV间期>55毫秒、希氏束下阻滞的检测、或在起搏周期长度>400毫秒的心房递减起搏时出现二度房室传导阻滞。
在2435例筛查患者中，确定了228例符合条件的患者，其中145例植入了起搏器。Kaplan-Meier分析确定，有起搏器患者至事件（晕厥或死亡）发生时间为50.1个月（95%置信区间45.4 - 54.8个月），无起搏器患者为37.8个月（95%置信区间31.3 - 44.4个月）（对数秩检验，P = 0.001）。4年时晕厥发生率的时间依赖性估计分别为12%和44%（P < 0.001），任何原因死亡发生率分别为41%和56%（P = 0.023）。在对潜在混杂因素进行调整后，多变量优势比为0.25（95%置信区间0.15 - 0.40）。
在不明原因晕厥且侵入性EPT显示窦房结功能障碍或房室传导受损迹象的患者中，起搏器植入与更长的无晕厥生存期独立相关。在主要结局指标（晕厥和任何原因死亡）的各个组成部分中也显示出显著差异。
