Permanent pacemaker implantation in octogenarians with unexplained syncope and positive electrophysiologic testing

被引:6
|
作者
Giannopoulos, Georgios [1 ,2 ]
Kossyvakis, Charalampos [1 ]
Panagopoulou, Vasiliki [2 ]
Tsiachris, Dimitrios [3 ]
Doudoumis, Konstantinos [1 ]
Mavri, Maria [1 ]
Vrachatis, Dimitrios [1 ]
Letsas, Konstantinos [4 ]
Efremidis, Michael [4 ]
Katsivas, Apostolos [5 ]
Lekakis, John [2 ]
Deftereos, Spyridon [2 ]
机构
[1] Athens Gen Hosp G Gennimatas, Dept Cardiol, Athens, Greece
[2] Univ Athens, Attikon Univ Hosp, Sch Med, Dept Cardiol 2, 1 Rimini St, Athens 12462, Greece
[3] Athens Med Ctr, Athens Heart Ctr, Athens, Greece
[4] Evangelismos Gen Hosp, Dept Cardiol 2, Athens, Greece
[5] Hellen Red Cross Hosp, Dept Cardiol 1, Athens, Greece
关键词
Pacing; EPS; Electrophysiologic; Electrophysiologic study; Mortality; QUALITY-OF-LIFE; MYOCARDIAL-INFARCTION; ELDERLY-PATIENTS; SINUS SYNDROME; GUIDELINES; OUTCOMES; THERAPY; UPDATE;
D O I
10.1016/j.hrthm.2017.01.012
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND 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 dear, especially in the elderly. OBJECTIVE 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). METHODS 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. RESULTS 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. CONCLUSION 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). (C) 2017 Heart Rhythm Society. All rights reserved.
引用
收藏
页码:694 / 699
页数:6
相关论文
共 50 条
  • [21] UNEXPLAINED SYNCOPE - RESULTS OF THERAPY BASED ON ELECTROPHYSIOLOGIC STUDIES
    DIMARCO, JP
    GARAN, H
    HARTHORNE, JW
    RUSKIN, JN
    AMERICAN JOURNAL OF CARDIOLOGY, 1981, 47 (02): : 433 - 433
  • [22] THE ROLE OF ELECTROPHYSIOLOGIC STUDIES IN THE MANAGEMENT OF PATIENTS WITH UNEXPLAINED SYNCOPE
    DENES, P
    EZRI, MD
    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1985, 8 (03): : 424 - 435
  • [23] UNEXPLAINED SYNCOPE - RESULTS OF THERAPY BASED ON ELECTROPHYSIOLOGIC STUDIES
    DIMARCO, JP
    GARAN, H
    HARTHORNE, JW
    RUSKIN, JN
    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1981, 4 (02): : 243 - 243
  • [24] INTRACARDIAC ELECTROPHYSIOLOGIC STUDIES (EPS) IN PATIENTS WITH UNEXPLAINED SYNCOPE
    SUGRUE, D
    HOLMES, D
    HAMMILL, S
    MCLARAN, C
    WOOD, D
    OSBORN, M
    GERSH, B
    CHEST, 1985, 88 : S24 - S24
  • [25] PERMANENT PACEMAKER IMPLANTATION
    CRICK, JCP
    BRITISH JOURNAL OF HOSPITAL MEDICINE, 1984, 31 (02): : 116 - &
  • [26] SERIAL ELECTROPHYSIOLOGIC TESTING WITH A PERMANENT PACEMAKER AFTER ACUTE MYOCARDIAL-INFARCTION
    LUCK, JC
    WYNDHAM, CRC
    MANN, DE
    BATTY, JW
    HERRE, JM
    GRIFFIN, JC
    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1984, 7 (04): : 663 - 667
  • [27] Implantation of a permanent pacemaker in a pregnant woman under the guidance of electrophysiologic signals and transthoracic echocardiography
    Pedrinazzi, Claudio
    Gazzaniga, Pietro
    Durin, Ornella
    Tovena, Daniela
    Inama, Giuseppe
    JOURNAL OF CARDIOVASCULAR MEDICINE, 2008, 9 (11) : 1169 - 1172
  • [28] SEDATION AND PAIN MANAGEMENT DURING PACEMAKER IMPLANTATION, ELECTROPHYSIOLOGIC TESTING, AND RELATED PROCEDURES
    MALONEY, JD
    CASTLE, L
    MORANT, V
    STERBA, R
    CLINICAL THERAPEUTICS, 1985, 8 (01) : 84 - 89
  • [29] Sleep Syncope: Treatment with a Permanent Pacemaker
    Rytlewski, Jason A.
    Lee, John T.
    Raj, Satish R.
    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2012, 35 (07): : E206 - E209
  • [30] Efficacy and safety of leadless pacemaker implantation in octogenarians
    Hofer, Daniel
    Regoli, Francois
    Saguner, Ardan M.
    Conte, Giulio
    Jelisejevas, Julius
    Luce Caputo, Maria
    Graup, Vera
    Gauthier, LorenzoGrazioli
    Gasperetti, Alessio
    Steffel, Jan
    Auricchio, Angelo
    Breitenstein, Alexander
    CARDIOLOGY, 2023, 148 (05) : 441 - 447