SPC365

Effectiveness of cardiac pacing in the prevention of neurocardiogenic syncope in patients with cardioinhibitory response on head-up tilt test

Session: Posters (Sessão 4 - Écran 5) - Pacing
Speaker: Ana Raquel Carvalho Santos

Congress: CPC 2023
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.6 Device Therapy - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Ana Raquel Carvalho Santos; Sofia Jacinto; Ana Lousinha; Madalena Coutinho Cruz; Guilherme Portugal; Pedro Silva Cunha; Sérgio Laranjo; Margarida Paulo; Manuel Brás; Ana Sofia Delgado; Rita Contins; Catarina Oliveira; Helena Fonseca; Mário Martins Oliveira; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:9.5pt"><span style="font-family:&quot;ProximaNovaCond-Light&quot;,sans-serif">The proper management of patients (P) with cardioinhibitory (CI) syncope has been the subject of much debate. Since the 2021 ESC guidelines on cardiac pacing, dual-chamber pacemaker therapy is a class IA in P with severe, unpredictable, recurrent syncope and an asystole either documented on implantable cardiac monitoring, induced by carotid sinus massage or head-up tilt test (HUTT). The pacing therapy will not completely eliminate recurrence of syncope in the long term and recent studies documented a recurrence rate of 20-22% at 3 years of P with pacemaker implantation regardless of the index diagnostic test. HUTT usefulness is still questioned, as pacing may affect the CI component of the vasovagal reflex without affecting the vasodepressor component, that can dominate. This uncertain benefit of pacing and HUTT for P</span></span><span style="font-size:9.5pt">&rsquo;</span><span style="font-size:9.5pt"><span style="font-family:&quot;ProximaNovaCond-Light&quot;,sans-serif"> selection arises the need of further research on the subject.</span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:9.5pt"><span style="font-family:&quot;ProximaNovaCond-Light&quot;,sans-serif">Objective:</span></span></strong><span style="font-size:9.5pt"><span style="font-family:&quot;ProximaNovaCond-Light&quot;,sans-serif"> To evaluate the effectiveness of dual-chamber pacing in P with a CI response on HUTT.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:9.5pt"><span style="font-family:&quot;ProximaNovaCond-Light&quot;,sans-serif">Methods: </span></span></strong><span style="font-size:9.5pt"><span style="font-family:&quot;ProximaNovaCond-Light&quot;,sans-serif">This retrospective non-randomized study included P with a CI response in HUTT and pacemaker implantation between 2003 and September of 2022. To evaluate syncopal recurrence during follow-up, review of recent medical records and telephone P interview were made. Descriptive statistics are presented as absolute frequency (number) and relative frequency (percentage) for categorical variables and as median and interquartile range (IQR) for continuous variables. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:9.5pt"><span style="font-family:&quot;ProximaNovaCond-Light&quot;,sans-serif">Results: </span></span></strong><span style="font-size:9.5pt"><span style="font-family:&quot;ProximaNovaCond-Light&quot;,sans-serif">There were 40 P with a CI response on HUTT resulting in pacemaker implantation. The median follow-up time was 4.5 years (2.25-9.75). The majority were female, 57.5% (n=23), with a median age of 60 years (44-69), 35% were on antihypertensive therapy, 10% were diabetic, 2.5% had medicated peripheral vertigo and 20% had a previous neurologic disorder (stroke 5%, epilepsy 7.5%, narcolepsy 2.5% and migraine 2.5%). Asymptomatic sinus bradycardia was documented in 15% of patients before HUTT. Median time until syncope on HUTT was 1440 seconds (s) (432-1694) with a median pause on HUTT 22 s (9-36). During follow up, 12.5% (n=5) had a new syncopal event and 22.5% (n=9) had recurrence of prodromal symptoms. Syncopal recurrence occurred exclusively among the female population. &nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:9.5pt"><span style="font-family:&quot;ProximaNovaCond-Light&quot;,sans-serif">Conclusion: </span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:9.5pt"><span style="font-family:&quot;ProximaNovaCond-Light&quot;,sans-serif">When analysing patients</span></span><span style="font-size:9.5pt">&rsquo;</span><span style="font-size:9.5pt"><span style="font-family:&quot;ProximaNovaCond-Light&quot;,sans-serif"> selection regardless of the index diagnostic test applied, in recent studies, there were higher rates of syncopal recurrence. Our series with HUTT selection of patients has a lower recurrence rate of syncope than previously described. </span></span></span></span></p>