© 2000 by European Society of Cardiology
Clinical experience of a new rate drop response algorithm in the treatment of vasovagal and carotid sinus syncope
1Department of Cardiology, Odense University Hospital Odense, Denmark; 2Department of Cardiology, Regional Cardiothoracic Centre, Freeman Hospital Newcastle upon Tyne, U.K.; 3Cardiac Rhythm Management, Medtronic, Inc. Minneapolis, U.S.A.
Dual chamber pacing has proven beneficial in patients with sudden drops in heart rate as seen in vasovagal syncope and carotid sinus syndrome. Newer algorithms for faster detection of an insidious drop in heart rate and short lasting intervention pacing at a high rate, as in the rate drop response algorithm in the Medtronic Kappa series of pacemakers, might improve the effect of pacing. Two case reports, that demonstrate the use of these rate drop response algorithms, are presented. A 24-year-old woman with recurrent episodes of syncope and repeated tilt-table tests with vasovagal cardioinhibitory outcomes had a Medtronic Kappa 400 pacemaker implanted. Syncope was abolished during repeat tilt-table testing following pacemaker implantation and proper functioning of the rate drop response algorithm. The patient has been free of syncope during follow-up apart from a single episode that occurred due to neglect of vasovagal warning symptoms. A 52-year-old man with coronary artery disease developed recurrent blackouts. Carotid sinus massage resulted in 5·5 s of asystole and presyncope. A Medtronic Kappa 700 pacemaker with a rate drop response algorithm was implanted and the patient became asymptomatic. The rate drop response algorithm is discussed in detail based upon the case reports, and recommendations are given for the use of this algorithm in patients with vasovagal syncope and carotid sinus syndrome.
Key Words: Neurocardiogenic syncope, vasovagal syncope, carotid sinus syncope, dual chamber pacing, pacemaker programming, rate drop response algorithm
Correspondence: Dr Jens Brock Johansen, Department of Cardiology, Odense University Hospital, DK-5000 Odense C, Denmark. Email: brock{at}med.ou.dk
[1] Gregoratos G, Cheitlin MD, Conill A, et al. ACC/AHA Guidelines for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee in Pacemaker Implantation). J Am Coll Card 1998; 31: 1175–1209.
[2] Gammage MD, Hess M, Markowitz T. Initial experience with a rate drop response algorithm in malignant vasovagal syncope. Eur J Cardiac Pacing Electro-physiol 1995; 5: 45–48.
[3] Abe H, Iwami Y, Nagatomo T, Miura Y, Nakashima Y. Treatment of malignant neurocardiogenic vasovagal syncope with a rate drop algorithm in dual chamber cardiac pacing. PACE 1998; 21: 1473–1475.
[4] Benditt DG, Petersen M, Lurie KG, Grubb BP, Sutton R. Cardiac pacing for prevention of recurrent vasovagal syncope. Ann Intern Med 1995; 122: 204–209.
[5] Benditt DG, Sutton RS, Gammage MD, et al. Clinical experience with Thera DR rate-drop response pacing algorithm in carotid sinus syndrome and vasovagal syncope. PACE 1997; 20: 832–839.
[6] Connolly SJ, Sheldon R, Robertson RS, Gent M. The North American Vasovagal Pacemaker Study (VPS). A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. J Am Coll Cardiol 1999; 33: 16–20.
[7] Sheldon R, Koshman ML, Wilson W, Kieser T, Rose S. Effect of dual-chamber pacing with automatic rate-drop sensing on recurrent neurally mediated syncope. Am J Cardiol 1998; 81: 158–162.[CrossRef][Web of Science][Medline]
[8] Bexton RS, Davis A, Kenny RA. The rate-drop response in carotid sinus syndrome: the Newcastle experience. PACE 1997; 20: 840.
[9] Brignole M, Sutton R, Raviele A, et al. Dual chamber pacing is efficacious in treatment of neurally mediated tilt positive cardioinhibitory syncope: pacemaker versus no therapy: a multicentre randomized study (Abstr). Circulation 1999; 100:Suppl_I I–642.
[10] Sutton R and Petersen MEV. First steps toward a pacing algorithm for vasovagal syncope. PACE 1997; 20: 827–828.
[11] Kurbaan AS and Sutton R. Pacing for vasovagal syncope. Heart 1999; 82: 649–650.
[12] Fitzpatrick AP, Theodorakis G, Vardas P, Sutton R. Methodology of head-up tilt testing in patients with unexplained syncope. J Am Coll Cardiol 1991; 17: 125–130.[Abstract]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  E. N. Simantirakis, E. G. Arkolaki, and P. E. Vardas Novel pacing algorithms: do they represent a beneficial proposition for patients, physicians, and the health care system? Europace, October 1, 2009; 11(10): 1272 - 1280. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Brignole, R. Sutton, W. Wieling, S.N. Lu, M.K. Erickson, T. Markowitz, N. Grovale, F. Ammirati, D.G. Benditt, and on behalf of the ISSUE 2 investigators Analysis of rhythm variation during spontaneous cardioinhibitory neurally-mediated syncope. Implications for RDR pacing optimization: an ISSUE 2 substudy Europace, May 1, 2007; 9(5): 305 - 311. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||