Europace Advance Access originally published online on September 5, 2007
Europace 2007 9(10):932-936; doi:10.1093/europace/eum180
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SYNCOPE
Less syncope and milder symptoms in patients treated with pacing for induced cardioinhibitory carotid sinus syndrome: a randomized study
1 School of Life Sciences, University of Skövde, P.O. Box 408, S-541 28 Skövde, Sweden; 2 Department of Cardiology, Central Hospital, Skövde, Sweden; 3 Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden; 4 Institute of Medicine, The Sahlgrenska Academy, Göteborg University, Göteborg, Sweden
Aims The aim of this study was to examine the effect on symptoms in patients with induced cardioinhibitory carotid sinus syndrome (ICSS) when treated or not treated with a pacemaker.
Methods and results Sixty patients with a history of syncope or pre-syncope and ICSS were randomized to receive a permanent pacemaker (P group, n = 30) or no pacing (NP group, n = 30). ICSS was defined as a ventricular pause (i.e. asystole) lasting 3 s or more in response to carotid sinus stimulation. The patients were seen at 3 and 12 months and at symptoms. At 12 months, the rate of syncope in the NP group was 40% (n = 12) compared with 10% (n = 3) in the P group (P = 0.008). The majority (11 of 12) of the syncope recurrences in the NP group occurred during the first 3 months. Pre-syncope occurred in two patients (7%) in the NP group and in eight (27%) in the P group. Ten patients (33%) with recurrent syncope in the NP group later crossed-over to receive pacemaker implant.
Conclusions A history of syncope or pre-syncope, plus ICSS, was a strong predictor of subsequent syncope or pre-syncope. Most of the new symptoms occurred within 3 months. Pacemaker treatment effectively reduced syncope and/or resulted in milder symptoms.
Key Words: Carotid sinus syndrome, Unexplained syncope, Pacemaker
* Corresponding author. Tel: +46 500 448645. E-mail address: jan-eric.claesson{at}his.se
Manuscript submitted 19 February 2007. Accepted after revision 24 July 2007.
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  Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), Endorsed by the following societies, European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC) Eur. Heart J., November 1, 2009; 30(21): 2631 - 2671. [Full Text] [PDF]
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