Benditt D G, Sutton R, Gammage M D, Markowitz T, Gorski J, Nygaard G A, Fetter J
Department of Medicine, University of Minnesota Medical School, Minneapolis 55455, USA.
Pacing Clin Electrophysiol. 1997 Mar;20(3 Pt 2):832-9. doi: 10.1111/j.1540-8159.1997.tb03916.x.
This study examined the effectiveness of cardiac pacing using the Thera DR rate-drop response algorithm for prevention of recurrent symptoms in patients with carotid sinus syndrome (CSS) or vasovagal syncope. The algorithm comprises both diagnostic and treatment elements. The diagnostic element consists of a programmable "window" used to identify heart rate changes compatible with an evolving neurally mediated syncopal episode. The treatment arm consists of pacing at a selectable rate and for a programmable duration. Forty-three patients (mean age 53 +/- 20.4 years) with CSS alone (n = 8), CSS in conjunction with vasovagal syncope (n = 4), or vasovagal syncope alone (n = 31) were included. Thirty-nine had recurrent syncope, while the remaining four reported multiple presyncopal events. Prior to pacing, 40 +/- 152 syncopal episodes (range from 1 to approximately 1,000 syncopal events) over the preceding 56 +/- 84.5 months. Postpacing follow-up duration was 204 +/- 172 days. Three patients have been lost to follow-up and in one patient the algorithm was disabled. Among the remaining 39 individuals, 31 (80%) indicated absence or diminished frequency of symptoms, or less severe symptoms. Twenty-three patients (23/29, or 59%) were asymptomatic with respect to syncope or presyncope. Sixteen patients had symptom recurrences. Of these, seven experienced syncope (7/39, or 18%) and 9 (29%) had presyncope: the majority of patients with recurrences (6/7 syncope and 7/9 presyncope) were individuals with a history of vasovagal syncope. Consequently, although symptoms were observed during postpacing follow-up, they appeared to be of reduced frequency and severity. Thus, our findings suggest that a transient period of high rate pacing triggered by the Thera DR rate-drop response algorithm was beneficial in a large proportion of highly symptomatic patients with CSS or vasovagal syncope.
本研究探讨了使用Thera DR心率下降反应算法进行心脏起搏对预防颈动脉窦综合征（CSS）或血管迷走性晕厥患者复发症状的有效性。该算法包括诊断和治疗要素。诊断要素包括一个可编程的“窗口”，用于识别与正在发生的神经介导性晕厥发作相符的心率变化。治疗措施包括以可选择的心率和可编程的持续时间进行起搏。纳入了43例患者（平均年龄53±20.4岁），其中单纯CSS患者8例，合并血管迷走性晕厥的CSS患者4例，单纯血管迷走性晕厥患者31例。39例有复发性晕厥，其余4例报告有多次晕厥前发作。起搏前，在之前56±84.5个月内有40±152次晕厥发作（范围从1次到约1000次晕厥事件）。起搏后随访时间为204±172天。3例患者失访，1例患者的算法被停用。在其余39例患者中，31例（80%）表示症状消失或频率降低，或症状减轻。23例患者（23/29，即59%）在晕厥或晕厥前无症状。16例患者症状复发。其中，7例发生晕厥（7/39，即18%），9例有晕厥前发作（29%）：大多数复发患者（6/7晕厥和7/9晕厥前发作）是有血管迷走性晕厥病史的个体。因此，尽管在起搏后随访期间观察到了症状，但它们的频率和严重程度似乎有所降低。因此，我们的研究结果表明，由Thera DR心率下降反应算法触发的短暂高速率起搏期对大部分有高度症状的CSS或血管迷走性晕厥患者有益。
