Temporal relationship between haemodynamic changes and activation of closed-loop stimulation during a tilt-induced vasovagal syncope.
Europace
; 26(2)2024 Feb 01.
Article
en En
| MEDLINE
| ID: mdl-38340330
ABSTRACT
AIMS:
A dual-chamber pacemaker with closed-loop stimulation (CLS) mode is effective in reducing syncopal recurrences in patients with asystolic vasovagal syncope (VVS). In this study, we explored the haemodynamic and temporal relationship of CLS during a tilt-induced vasovagal reflex. METHODS ANDRESULTS:
Twenty patients underwent a tilt test under video recording 3.9 years after CLS pacemaker implantation. Three patients were excluded from the analysis because of no VVS induced by the tilt test (n = 1) and protocol violation (n = 2). In 14 of the remaining 17 patients, CLS pacing emerged during the pre-syncopal phase of circulatory instability when the mean intrinsic heart rate (HR) was 88 ± 12â b.p.m. and systolic blood pressure (SBP) was 108 ± 19â mmHg. The CLS pacing rate thereafter rapidly increased to 105 ± 14â b.p.m. within a median of 0.1â min [inter-quartile range (IQR), 0.1-0.7â min] when the SBP was 99 ± 21â mmHg. At the time of maximum vasovagal effect (syncope or pre-syncope), SBP was 63 ± 17â mmHg and the CLS rate was 95 ± 13â b.p.m. The onset of CLS pacing was 1.7â min (IQR, 1.5-3.4) before syncope or lowest SBP. The total duration of CLS pacing was 5.0â min (IQR, 3.3-8.3). Closed-loop stimulation pacing was not observed in three patients who had a similar SBP decrease from 142 ± 22â mmHg at baseline to 69 ± 4â mmHg at the time of maximum vasovagal effect, but there was no significant increase in HR (59 ± 1â b.p.m.).CONCLUSION:
The reproducibility of a vasovagal reflex was high. High-rate CLS pacing was observed early during the pre-syncopal phase in most patients and persisted, although attenuated, at the time of maximum vasovagal effect. REGISTRATION ClinicalTrials.gov identifier NCT06038708.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Marcapaso Artificial
/
Síncope Vasovagal
Límite:
Humans
Idioma:
En
Revista:
Europace
Asunto de la revista:
CARDIOLOGIA
/
FISIOLOGIA
Año:
2024
Tipo del documento:
Article
País de afiliación:
Italia