14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

RT-76

The role of cardiac pacing for the treatment of cardioinhibitory vasovagal syncope: the VASIS study and beyond

Michele Brignole, Richard Sutton, Carlo Menozzi, Antonio Raviele, Paolo Alboni, Paolo Giani, Angel Moya on behalf of the Vasovagal Syncope International Study (VASIS) Investigators*.
Departments of Cardiology oc:\www Ospedali Riuniti, Lavagna, Italy, Royal Brompton Hospital, London, UK, Ospedale S. Maria Nuova, Reggio Emilia, Ospedale Umberto I, Mestre, Ospedale Civile, Cento, Ospedale Bolognini, Seriate, Italy, Hospital Vall d’Hebron, Barcelona, Spain. *A complete list of Investigators appears in Appendix

Abstract

BACKGROUND. This study was performed to compare implantation of a DDI pacemaker with rate hysteresis with no implant in respect of syncopal recurrences in patients with severe cardioinhibitory tilt positive neurally-mediated syncope.

METHODS AND RESULTS. Forty-two patients from 18 European centres were randomized to receive a DDI pacemaker programmed to 80 bpm with hysteresis 45 bpm (#19 pts) or no pacemaker (#23 pts). Inclusion criteria were: ³3 syncopes/last 2 years and a positive cardioinhibitory (VASIS type 2A and 2B) response to tilt testing. The median number of previous syncopal episodes was 6; asystolic response to tilt testing was present in 36 (86%) cases (mean asystole 13.9±10.2 s). All the patients were followed-up for a minimum of 1.0 years and a maximum of 6.7 years (mean 3.7±2.2). One patient (5%) in the pacemaker arm experienced recurrence of syncope compared with 14 patients (61%) in the no-pacemaker arm (p=0.0006). In the no-pacemaker arm, the median time to first syncopal recurrence was 5 months with a rate of 0.44 per year. On repeat tilt testing, performed within 15 days after enrolment, positive responses were observed in 59% of patients with pacemaker and in 61% of patients without pacemaker (not significant).

CONCLUSIONS. DDI pacing with hysteresis reduces the likelihood of syncope in patients with tilt positive cardioinhibitory syncope. The benefit of the therapy is maintained over the long term. Even in untreated patients, the syncopal recurrence burden is low. A negative result of tilt testing is not a useful means to evaluate the efficacy of the therapy.

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