Analysis of rhythm variation during spontaneous cardioinhibitory neurally-mediated syncope. Implications for RDR pacing optimization: An ISSUE 2 substudy

M. Brignole, R. Sutton, W. Wieling, S. N. Lu, M. K. Erickson, T. Markowitz, N. Grovale, F. Ammirati, D. G. Benditt

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

Background: Little is known of the variations of the heart rate during spontaneous cardioinhibitory neurally-mediated syncope. Their knowledge has both academic and practical implications for the optimization of rate drop response (RDR) pacing mode. Methods and results: We describe variations of the rhythm occurring during 48 syncopal episodes documented by implantable loop recorder. The presyncopal phase of 18 s (interquartile range 9-65) was characterized by a fall in heart rate from 83 ± 20 bpm to maximal bradycardia or (multiple) asystolic pauses which lasted a median of 19 s (10-30). The recovery phase lasted 22 s (7-52). The total duration of the cardioinhibitory reflex was 85 s (47-116). We then calculated the potential increase in benefit that an optimally programmed drop rate detection could provide compared with a reference Lower Rate detection. Compared with Lower Rate detection (defined as two consecutive beats at 40 bpm), drop rate detection (assumed to be drop size = 20 bpm, detection window = 1 min, and drop rate = 50 bpm) would have been able to introduce intervention pacing, a median of 5.7 s (interquartile range -5.1 - -10.4) earlier in 28 cases (58%). Conclusion: Cardioinhibitory neurally-mediated reflex varies widely from a few seconds to some minutes. In our data the total duration was <2 min. Optimal RDR programming, being potentially able to anticipate the detection of the cardioinhibitory reflex by a few seconds, could provide an increase in benefit for cardiac pacing therapy in prevention of syncope.

Original languageEnglish (US)
Pages (from-to)305-311
Number of pages7
JournalEuropace
Volume9
Issue number5
DOIs
StatePublished - May 2007

Keywords

  • Cardioinhibition
  • Diagnosis
  • Electrocardiography
  • Implantable loop recorder
  • Pacing
  • Rate drop response
  • Syncope

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