A systematic review on recurrent cardioinhibitory vasovagal syncope: Does pacing therapy break the fall?

Gonçalo José Lopes da Cunha, Bruno Miguel Lopes Rocha, Rita Ventura Gomes, Beatriz Valente Silva, Gonçalo Mendes, Rui Morais, Inês Fornelos Araújo, Cândida Fonseca

Research output: Contribution to journalReview article

Abstract

Vasovagal reflex is the most common cause of syncope. Pacemaker with rate drop response (RDR) or closed-loop stimulation (CLS) anti-syncope algorithms have been studied in recurrent vasovagal syncope (VVS), with conflicting results. We aim to investigate the role of pacemaker therapy and anti-syncope pacing mode in cardioinhibitory recurrent VVS. MEDLINE, Cochrane Library and registered clinical trials were searched for single or double-blind randomized controlled trials on pacing as a treatment for recurrent VVS. Five studies were eligible, overall enrolling 228 patients. After pooling data from all trials, pacemaker therapy showed a 63% reduction in syncope recurrence compared to control [Risk Ratio (RR): 0.37; 95% CI: 0.14-0.98; I2 = 67%)]. Subgroup analyses suggested that the effect was greater in single-blind studies (RR: 0.07; 95% CI: 0.01-0.52, I2 = 0%). When comparing pacing algorithms, the results from RDR versus no pacing trials (n = 2) did not show a significant reduction in syncope recurrence (RR: 0.73; 95% CI: 0.25-2.16, I2 60 = 75%). In contrast, the data from the CLS versus standard pacing trials (n = 3) evidenced a statistically meaningful reduction in syncopal burden (RR: 0.18; 95% CI: 0.07-0.47, I2 = 0%). It is unclear whether pacemaker therapy reduces syncopal burden in cardioinhibitory recurrent VVS. However, our results suggest effectiveness of CLS pacing mode.

Original languageEnglish
JournalPACE - Pacing and Clinical Electrophysiology
DOIs
Publication statusPublished - 1 Jan 2019

Fingerprint

Vasovagal Syncope
Syncope
Odds Ratio
Single-Blind Method
Therapeutics
Recurrence
MEDLINE
Libraries
Reflex
Meta-Analysis
Randomized Controlled Trials
Clinical Trials

Keywords

  • pacing
  • quality of life
  • vagal syndromes

Cite this

da Cunha, Gonçalo José Lopes ; Rocha, Bruno Miguel Lopes ; Gomes, Rita Ventura ; Silva, Beatriz Valente ; Mendes, Gonçalo ; Morais, Rui ; Araújo, Inês Fornelos ; Fonseca, Cândida. / A systematic review on recurrent cardioinhibitory vasovagal syncope : Does pacing therapy break the fall?. In: PACE - Pacing and Clinical Electrophysiology. 2019.
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title = "A systematic review on recurrent cardioinhibitory vasovagal syncope: Does pacing therapy break the fall?",
abstract = "Vasovagal reflex is the most common cause of syncope. Pacemaker with rate drop response (RDR) or closed-loop stimulation (CLS) anti-syncope algorithms have been studied in recurrent vasovagal syncope (VVS), with conflicting results. We aim to investigate the role of pacemaker therapy and anti-syncope pacing mode in cardioinhibitory recurrent VVS. MEDLINE, Cochrane Library and registered clinical trials were searched for single or double-blind randomized controlled trials on pacing as a treatment for recurrent VVS. Five studies were eligible, overall enrolling 228 patients. After pooling data from all trials, pacemaker therapy showed a 63{\%} reduction in syncope recurrence compared to control [Risk Ratio (RR): 0.37; 95{\%} CI: 0.14-0.98; I2 = 67{\%})]. Subgroup analyses suggested that the effect was greater in single-blind studies (RR: 0.07; 95{\%} CI: 0.01-0.52, I2 = 0{\%}). When comparing pacing algorithms, the results from RDR versus no pacing trials (n = 2) did not show a significant reduction in syncope recurrence (RR: 0.73; 95{\%} CI: 0.25-2.16, I2 60 = 75{\%}). In contrast, the data from the CLS versus standard pacing trials (n = 3) evidenced a statistically meaningful reduction in syncopal burden (RR: 0.18; 95{\%} CI: 0.07-0.47, I2 = 0{\%}). It is unclear whether pacemaker therapy reduces syncopal burden in cardioinhibitory recurrent VVS. However, our results suggest effectiveness of CLS pacing mode.",
keywords = "pacing, quality of life, vagal syndromes",
author = "{da Cunha}, {Gon{\cc}alo Jos{\'e} Lopes} and Rocha, {Bruno Miguel Lopes} and Gomes, {Rita Ventura} and Silva, {Beatriz Valente} and Gon{\cc}alo Mendes and Rui Morais and Ara{\'u}jo, {In{\^e}s Fornelos} and C{\^a}ndida Fonseca",
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A systematic review on recurrent cardioinhibitory vasovagal syncope : Does pacing therapy break the fall? / da Cunha, Gonçalo José Lopes; Rocha, Bruno Miguel Lopes; Gomes, Rita Ventura; Silva, Beatriz Valente; Mendes, Gonçalo; Morais, Rui; Araújo, Inês Fornelos; Fonseca, Cândida.

In: PACE - Pacing and Clinical Electrophysiology, 01.01.2019.

Research output: Contribution to journalReview article

TY - JOUR

T1 - A systematic review on recurrent cardioinhibitory vasovagal syncope

T2 - Does pacing therapy break the fall?

AU - da Cunha, Gonçalo José Lopes

AU - Rocha, Bruno Miguel Lopes

AU - Gomes, Rita Ventura

AU - Silva, Beatriz Valente

AU - Mendes, Gonçalo

AU - Morais, Rui

AU - Araújo, Inês Fornelos

AU - Fonseca, Cândida

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Vasovagal reflex is the most common cause of syncope. Pacemaker with rate drop response (RDR) or closed-loop stimulation (CLS) anti-syncope algorithms have been studied in recurrent vasovagal syncope (VVS), with conflicting results. We aim to investigate the role of pacemaker therapy and anti-syncope pacing mode in cardioinhibitory recurrent VVS. MEDLINE, Cochrane Library and registered clinical trials were searched for single or double-blind randomized controlled trials on pacing as a treatment for recurrent VVS. Five studies were eligible, overall enrolling 228 patients. After pooling data from all trials, pacemaker therapy showed a 63% reduction in syncope recurrence compared to control [Risk Ratio (RR): 0.37; 95% CI: 0.14-0.98; I2 = 67%)]. Subgroup analyses suggested that the effect was greater in single-blind studies (RR: 0.07; 95% CI: 0.01-0.52, I2 = 0%). When comparing pacing algorithms, the results from RDR versus no pacing trials (n = 2) did not show a significant reduction in syncope recurrence (RR: 0.73; 95% CI: 0.25-2.16, I2 60 = 75%). In contrast, the data from the CLS versus standard pacing trials (n = 3) evidenced a statistically meaningful reduction in syncopal burden (RR: 0.18; 95% CI: 0.07-0.47, I2 = 0%). It is unclear whether pacemaker therapy reduces syncopal burden in cardioinhibitory recurrent VVS. However, our results suggest effectiveness of CLS pacing mode.

AB - Vasovagal reflex is the most common cause of syncope. Pacemaker with rate drop response (RDR) or closed-loop stimulation (CLS) anti-syncope algorithms have been studied in recurrent vasovagal syncope (VVS), with conflicting results. We aim to investigate the role of pacemaker therapy and anti-syncope pacing mode in cardioinhibitory recurrent VVS. MEDLINE, Cochrane Library and registered clinical trials were searched for single or double-blind randomized controlled trials on pacing as a treatment for recurrent VVS. Five studies were eligible, overall enrolling 228 patients. After pooling data from all trials, pacemaker therapy showed a 63% reduction in syncope recurrence compared to control [Risk Ratio (RR): 0.37; 95% CI: 0.14-0.98; I2 = 67%)]. Subgroup analyses suggested that the effect was greater in single-blind studies (RR: 0.07; 95% CI: 0.01-0.52, I2 = 0%). When comparing pacing algorithms, the results from RDR versus no pacing trials (n = 2) did not show a significant reduction in syncope recurrence (RR: 0.73; 95% CI: 0.25-2.16, I2 60 = 75%). In contrast, the data from the CLS versus standard pacing trials (n = 3) evidenced a statistically meaningful reduction in syncopal burden (RR: 0.18; 95% CI: 0.07-0.47, I2 = 0%). It is unclear whether pacemaker therapy reduces syncopal burden in cardioinhibitory recurrent VVS. However, our results suggest effectiveness of CLS pacing mode.

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KW - quality of life

KW - vagal syndromes

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U2 - 10.1111/pace.13790

DO - 10.1111/pace.13790

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JO - Pacing and Clinical Electrophysiology

JF - Pacing and Clinical Electrophysiology

SN - 0147-8389

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