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

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

RT-77

Electrical therapy for the prevention of the malignant vasovagal syncope: the DDD Closed Loop Stimulation

Eraldo Occhetta, Michele Maltese*, Corrado Vassanelli on behalf of the INVASY Preliminary Study Group.
Divisione Clinicizzata di Cardiologia, Facolta di Medicina e Chirurgia di Novara, Universita degli Studi del Piemonte Orientale, Novara, *Biotronik-Seda, Trezzano sul Naviglio, Italy

Abstract

Closed Loop Stimulation (CLS) is a new concept of heart rate modulation in cardiac pacing, by which the pacemaker becomes an integral part of the circulatory regulation and, therefore, reacts appropriately on cardiovascular demands. As changes of the contraction dynamics of the ventricular myocardium precede vasovagal fainting, a CLS pacemaker, sensitive to changes in myocardial contractility, could be useful for the treatment of this syndrome. The pacemaker INOS² CLS (Biotronik, Germany) derives its information for heart rate optimisation from myocardial contraction dynamics by measuring right ventricular intracardiac impedance. The aim of this preliminary study was to evaluate long term quality of life, including the first recurrence of syncope, after DDD-CLS pacing by INOS² CLS, in 22 patients with a history of more than 2 syncopal events per year and 2 consecutive positive head-up tilt tests. During a mean period of 8.5 months (from 3 to 24) all patients had no recurrent syncopal events in daily life with an improved quality of life. A randomised controlled study is warranted to further elucidate the mechanism of preventive effects of DDD-CLS pacing in the vasovagal syncopes and to confirm its beneficial effect observed so far.

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