The Role of Pacing in Elderly Patients with Unexplained Syncope
- PDF / 542,564 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 2 Downloads / 212 Views
ARRHYTHMIAS (J. BUNCH, SECTION EDITOR)
The Role of Pacing in Elderly Patients with Unexplained Syncope Justin Z. Lee 1 & Siva K. Mulpuru 1,2 & Win K. Shen 1 Published online: 26 April 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Purpose of Review To discuss the role of pacing in elderly patients with unexplained syncope. Recent Findings In patients with recurrent syncope with suspected reflex mechanism, the decision of pacemaker implantation can be guided by a standardized algorithm which includes carotid sinus massage, tilt-table testing, and implantable loop recorder. Cardiac pacing may reduce recurrent syncope in cardioinhibitory carotid sinus syndrome. In select elderly patients with recurrent cardioinhibitory vasovagal syncope, cardiac pacing may also reduce syncope recurrence. There is no role of cardiac pacing in patients with without a cardioinhibitory response. There is increasing evidence that closed loop stimulation reduces the recurrence of cardioinhibitory vasovagal syncope. In patients with syncope and a positive electrophysiology study consistent with sinoatrial or conduction system disease, cardiac pacing has been shown to reduce recurrent syncope. Cardiac pacing is also effective in reducing recurrent syncope when high-grade atrioventricular block is documented on electrocardiography monitoring. In elderly patients with unexplained syncope and bundle branch block on ECG, diagnostic algorithm should be followed according to guidelines; empirical pacing is generally not recommended. Summary Permanent pacemaker implantation may be effective to reduce recurrent syncope in select groups of elderly patients. It is important to consider additional investigations to evaluate elderly patients with unexplained syncope. The results of these testing would guide the decision on permanent pacemaker implantation. Keywords Syncope . Elderly . Pacemaker
Background Unexplained syncope is defined as syncope for which a cause is undetermined after an initial evaluation that is deemed appropriate by the experienced healthcare provider [1••]. The initial evaluation includes, but is not limited to, a thorough history, physical examination, and ECG. The subsequent diagnostic evaluation and management of unexplained syncope in the elderly remains challenging as this is a high-risk population [2] with multiple potential causes of syncope not necessarily related to bradycardia [3]. In many countries, the chronological age of 65 years has been accepted as the definition of an “elderly” person [4]. Syncope becomes This article is part of the Topical Collection on Arrhythmias * Win K. Shen [email protected] 1
Department of Cardiovascular Diseases, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
2
Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st St SW, Rochester, MN 55905, USA
increasingly common with increasing age, from 5.7 per 1000 patients per year in the 7th decade to 19.5 per 1000 patients per year in the 9th decade [2]. Elderly patients c
Data Loading...
