Letter by Lagro et al regarding article, "Treatment of unexplained syncope: a multicenter, randomized trial of cardiac pacing guided by adenosine 5'-triphosphate testing".
نویسندگان
چکیده
BACKGROUND The origin of 40% of syncope cases remains unknown even after a complete diagnostic workup. Previous studies have suggested that ATP testing has value in selecting successful therapy. This patient-blinded, multicenter, randomized superiority trial tested whether, in patients with syncope of unknown origin, selecting cardiac pacing in those with a positive ATP test leads to fewer recurrences than those who do not receive pacing. METHODS AND RESULTS From 2000 to 2005, 80 consenting patients (mean age, 75.9±7.7 years; 81% women; 56% without diagnosed structural heart disease) with syncope of unknown origin and atrioventricular or sinoatrial block lasting >10 seconds (average, 17.9±6.8 seconds) under ATP administration (20-mg IV bolus) were recruited from 10 hospitals, implanted with programmable pacemakers, and randomized to either active pacing (dual-chamber pacing at 70 bpm) or backup pacing (atrial pacing at 30 bpm). Patients were followed up regularly for up to 5 years for any syncope recurrence, the primary outcome. Mean follow-up was 16 months. Syncope recurred in 8 of 39 patients (21%) randomized to active pacing and in 27 of 41 (66%) randomized to backup pacing (control), yielding a hazard ratio of 0.25 (95% confidence interval, 0.12-0.56). After recurrence, the 27 recurrent control patients were reprogrammed to active pacing, and only 1 reported subsequent syncope. CONCLUSION This study suggests that, in elderly patients with syncope of unknown origin and positive ATP tests, active dual-chamber pacing reduces syncope recurrence risk by 75% (95% confidence interval, 44-88). CLINICAL TRIAL REGISTRATION URL: http://www.controlled-trials.com/ISRCTN00029383. Unique identifier: ISRCTN00029383.
منابع مشابه
Treatment of Unexplained Syncope A Multicenter, Randomized Trial of Cardiac Pacing Guided by Adenosine 5 -Triphosphate Testing
متن کامل
Treatment of Unexplained Syncope: A Multicenter, Randomized Trial of Cardiac Pacing Guided by Adenosine 5 -triphosphate Testing Running title: Flammang et al.; ATP test to select pacing in unexplained syncope
Croix Rousse University Hospital, Lyon, France; Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, MN; Louvain University Hospital, Mont Godinne, Belgium; Brest University Hospital, France; Gosselies and Gilly General Hospitals, Belgium; Arlon General Hospital, Belgium; Amiens University Hospital, France, currently at Georges Pompidou Europe...
متن کاملUpgrading from ventricular to physiological pacing: is it worth it?
1997; 77: 273–5. [32] Natale A, Beheiry S, Wase A et al. Occurrence of clinical asystole in patients without evidence of structural heart disease: response to tilt test and follow-up. Circulation 1999; 100: I-245. [33] Fitzpatrick A, Sutton R. Tilting towards a diagnosis in recurrent unexplained syncope. Lancet 1989; 1: 658–60. [34] Strasberg B, Rechavia E, Sagie A et al. The head-up tilt table...
متن کاملShould the 'adenosine-challenge test' be part of the routine work-up for syncope?
The adenosine compounds [adenosine and adenosine triphosphate (ATP)] exert negative chronotropic and dromotropic effects at the level of the sinus node and atrio-ventricular (AV) node. These effects are both potent and short lasting. Therefore, the adenosine compounds replaced verapamil as the first-line drug for terminating re-entrant supraventricular tachycardias involving the AV node (AV nod...
متن کاملPermanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope: a multicenter, randomized, controlled trial.
BACKGROUND This clinical investigation was performed to compare the effects of permanent dual-chamber cardiac pacing with pharmacological therapy in patients with recurrent vasovagal syncope. METHODS AND RESULTS Patients from 14 centers were randomized to receive either a DDD pacemaker provided with rate-drop response function or the beta-blocker atenolol at the dosage of 100 mg once a day. I...
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ورودعنوان ژورنال:
- Circulation
دوره 126 8 شماره
صفحات -
تاریخ انتشار 2012