TITLE

Pacemaker therapy did not reduce recurrent vasovagal syncope: COMMENTARY

AUTHOR(S)
Oral, Hakan; Eagle, Kirn A.
PUB. DATE
November 2003
SOURCE
ACP Journal Club;Nov/Dec2003, Vol. 139 Issue 3, p77
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
In a well-designed study, researchers S.J. Connolly and colleagues addresses whether dual-chamber pacing (DDD)with a rate-drop function decreases the incidence of recurrent syncope in patients with severe vasovagal syncope. This study is unique because all patients received a dual-chamber pacemaker before randomization, both the patients and the investigators were blinded to treatment assignment, and the study had the largest sample size to date improving the power to detect a treatment difference. Although the tilt table test (TIT) is widely used for assessment of patients with syncope, it has a modest sensitivity of 60% to 85%, whereas the specificity is about 90% depending on how aggressively provocative interventions are performed. In most patients with syncope, a detailed history may obviate the need for a TIT and consultations from specialists. Although some patients with vasovagal syncope who have a predominant cardio-inhibitory component may benefit from DDD, pacing should not be considered in patients with vasovagal syncope, or at least not as first-line therapy. Treatment of these patients depends on the severity and frequency of episodes and includes preventive measures as well as pharmacologic agents.
ACCESSION #
11533520

 

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