Neurocardiogenic syncope pacemaker therapy: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
(/* ACC/AHA Guidelines- Permanent Pacing in Hypersensitive Carotid Sinus Syndrome and Neurocardiogenic Syncope (DO NOT EDIT){{cite journal |author=Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, H...)
 
(4 intermediate revisions by one other user not shown)
Line 1: Line 1:
__NOTOC__
{{Neurocardiogenic syncope}}
{{Neurocardiogenic syncope}}
{{CMG}}; {{AOEIC}} {{LG}}


==ACC / AHA Guidelines- Permanent Pacing in Hypersensitive Carotid Sinus Syndrome and Neurocardiogenic Syncope (DO NOT EDIT) <ref name="Epstein"> Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM III, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). Circulation. 2008; 117: 2820–2840. PMID 18483207 </ref>==
==Overview==
{{cquote|
Neurocardiogenic syncope is usually a self-limited episode of [[hypotension|systemic hypotension]] characterized by both [[bradycardia]] (asystole or relative bradycardia) and [[vasodilation|peripheral vasodilation]].<ref name="pmid15939833">{{cite journal |author=Grubb BP |title=Neurocardiogenic syncope and related disorders of orthostatic intolerance |journal=[[Circulation]] |volume=111 |issue=22 |pages=2997–3006 |year=2005 |month=June |pmid=15939833 |doi=10.1161/CIRCULATIONAHA.104.482018 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15939833 |accessdate=2012-05-17}}</ref><ref name="pmid8752825">{{cite journal |author=Benditt DG, Ferguson DW, Grubb BP, Kapoor WN, Kugler J, Lerman BB, Maloney JD, Raviele A, Ross B, Sutton R, Wolk MJ, Wood DL |title=Tilt table testing for assessing syncope. American College of Cardiology |journal=[[Journal of the American College of Cardiology]] |volume=28 |issue=1 |pages=263–75 |year=1996 |month=July |pmid=8752825 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0735109796002367 |accessdate=2012-05-17}}</ref>
===Class I===
1. Permanent [[pacemaker|pacing]] is indicated for recurrent [[syncope]] caused by spontaneously occurring [[carotid sinus]] stimulation and [[carotid sinus]] pressure that induces [[ventricular asystole]] of more than 3 seconds. ''(Level of Evidence: C)''


===Class IIa===
[[Artificial pacemaker|Dual chamber pacing (DDD)]] is indicated only in patients with refractory neurocardiogenic syncope with significant [[bradycardia]] or [[asystole]]. In addition to cardiac pacing, adjunctive medical therapy may also be required as cardiac pacing alone has shown to be ineffective.
1. Permanent [[pacemaker|pacing]] is reasonable for [[syncope]] without clear, provocative events and with a hypersensitive cardioinhibitory response of 3 seconds or longer. ''(Level of Evidence: C)''


===Class IIb===
==Indications==
1. Permanent [[pacemaker|pacing]] may be considered for significantly symptomatic neurocardiogenic [[syncope]] associated with [[bradycardia]] documented spontaneously or at the time of tilt-table testing. ''(Level of Evidence: B)''
*Refractory neurocardiogenic syncope with significant [[bradycardia]] or [[asystole]].<ref name="pmid10899092">{{cite journal |author=Sutton R, Brignole M, Menozzi C, Raviele A, Alboni P, Giani P, Moya A |title=Dual-chamber pacing in the treatment of neurally mediated tilt-positive cardioinhibitory syncope : pacemaker versus no therapy: a multicenter randomized study. The Vasovagal Syncope International Study (VASIS) Investigators |journal=[[Circulation]] |volume=102 |issue=3 |pages=294–9 |year=2000 |month=July |pmid=10899092 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10899092 |accessdate=2012-05-17}}</ref><ref name="pmid11435337">{{cite journal |author=Ammirati F, Colivicchi F, Santini M |title=Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope: a multicenter, randomized, controlled trial |journal=[[Circulation]] |volume=104 |issue=1 |pages=52–7 |year=2001 |month=July |pmid=11435337 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11435337 |accessdate=2012-05-17}}</ref><ref name="pmid9935002">{{cite journal |author=Connolly SJ, Sheldon R, Roberts RS, Gent M |title=The North American Vasovagal Pacemaker Study (VPS). A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope |journal=[[Journal of the American College of Cardiology]] |volume=33 |issue=1 |pages=16–20 |year=1999 |month=January |pmid=9935002 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S073510979800549X |accessdate=2012-05-17}}</ref> Among patients with significant [[bradycardia]], despite the successful demonstration of permanent pacers to increase time to first syncopal episode and to reduce recurrent episodes by the VASIS study <ref name="pmid10899092">{{cite journal |author=Sutton R, Brignole M, Menozzi C, Raviele A, Alboni P, Giani P, Moya A |title=Dual-chamber pacing in the treatment of neurally mediated tilt-positive cardioinhibitory syncope : pacemaker versus no therapy: a multicenter randomized study. The Vasovagal Syncope International Study (VASIS) Investigators|journal=[[Circulation]] |volume=102 |issue=3 |pages=294–9 |year=2000 |month=July|pmid=10899092 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10899092 |accessdate=2012-05-17}}</ref> and the VPS study <ref name="pmid9935002">{{cite journal |author=Connolly SJ, Sheldon R, Roberts RS, Gent M |title=The North American Vasovagal Pacemaker Study (VPS). A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope |journal=[[Journal of the American College of Cardiology]] |volume=33 |issue=1 |pages=16–20 |year=1999 |month=January |pmid=9935002 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S073510979800549X |accessdate=2012-05-17}}</ref> respectively, the recent VPS-II study, did not demonstrate any reduction in the risk of recurrent syncopal events.<ref name="pmid12734133">{{cite journal |author=Connolly SJ, Sheldon R, Thorpe KE, Roberts RS, Ellenbogen KA, Wilkoff BL, Morillo C, Gent M |title=Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope: Second Vasovagal Pacemaker Study (VPS II): a randomized trial |journal=[[JAMA : the Journal of the American Medical Association]] |volume=289 |issue=17 |pages=2224–9 |year=2003 |month=May |pmid=12734133 |doi=10.1001/jama.289.17.2224 |url=http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.289.17.2224 |accessdate=2012-05-17}}</ref> Therefore, the use of cardiac pacing in such patient population still remains controversial.   


===Class III===
*If cardiac pacing is indicated, [[Artificial pacemaker|dual chamber pacing]] is preferred following the demonstration of a strong positive [[tilt table test]]. Adjunctive medical therapy should be continued as it has shown to be more effective than pacing alone.
1. Permanent [[pacemaker|pacing]] is not indicated for a hypersensitive cardioinhibitory response to [[carotid sinus]] stimulation without symptoms or with vague symptoms. ''(Level of Evidence: C)''


2. Permanent [[pacemaker|pacing]] is not indicated for situational vasovagal [[syncope]] in which avoidance behavior is effective and preferred. ''(Level of Evidence: C)''}}
==ACC/AHA Guidelines- Permanent Pacing in Hypersensitive Carotid Sinus Syndrome and Neurocardiogenic Syncope (DO NOT EDIT)<ref name="pmid18483207">{{cite journal |author=Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW |title=ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons |journal=[[Circulation]] |volume=117 |issue=21 |pages=e350–408 |year=2008 |month=May |pmid=18483207 |doi=10.1161/CIRCUALTIONAHA.108.189742 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18483207 |accessdate=2012-05-17}}</ref>==


==Sources==
{|class="wikitable"
* The ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities <ref name="Epstein"> Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM III, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). Circulation. 2008; 117: 2820–2840. PMID 18483207 </ref>
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Permanent [[pacemaker|pacing]] is indicated for recurrent [[syncope]] caused by spontaneously occurring [[carotid sinus]] stimulation and [[carotid sinus]] pressure that induces [[ventricular asystole]] of more than 3 seconds. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Permanent [[pacemaker|pacing]] is reasonable for [[syncope]] without clear, provocative events and with a hypersensitive cardioinhibitory response of 3 seconds or longer. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Permanent [[pacemaker|pacing]] is reasonable for [[syncope]] without clear, provocative events and with a hypersensitive cardioinhibitory response of 3 seconds or longer. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
 
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
|-
|bgcolor="LightCoral"| <nowiki>"</nowiki> '''1.''' Permanent [[pacemaker|pacing]] is not indicated for a hypersensitive cardioinhibitory response to [[carotid sinus]] stimulation without symptoms or with vague symptoms. ''(Level of Evidence: C)'' <nowiki>"</nowiki>
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki> '''2.''' Permanent [[pacemaker|pacing]] is not indicated for situational vasovagal [[syncope]] in which avoidance behavior is effective and preferred. ''(Level of Evidence: C)'' <nowiki>"</nowiki>
|}
 
==Guideline Resource==
[http://circ.ahajournals.org/content/117/21/e350.full.pdf The ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities] <ref name="pmid18483207">{{cite journal |author=Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW |title=ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons |journal=[[Circulation]] |volume=117 |issue=21 |pages=e350–408 |year=2008 |month=May |pmid=18483207 |doi=10.1161/CIRCUALTIONAHA.108.189742 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18483207 |accessdate=2012-05-17}}</ref>


==References==
==References==
Line 26: Line 52:
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Cardiology]]

Latest revision as of 14:02, 19 October 2012

Neurocardiogenic Syncope Microchapters

Home

Patient Info

Overview

Pathophysiology

Epidemiology and Demographics

Risk Factors

Causes

Natural History, Complications & Prognosis

Differentiating Neurocardiogenic Syncope From Other Diseases

Diagnosis

History & Symptoms

Physical Examination

Tilt Table Testing

Treatment

Pharmacotherapy

Pacemaker therapy

Neurocardiogenic syncope pacemaker therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Neurocardiogenic syncope pacemaker therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Neurocardiogenic syncope pacemaker therapy

CDC on Neurocardiogenic syncope pacemaker therapy

Neurocardiogenic syncope pacemaker therapy in the news

Blogs on Neurocardiogenic syncope pacemaker therapy

Directions to Hospitals Treating Neurocardiogenic Syncope

Risk calculators and risk factors for Neurocardiogenic syncope pacemaker therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

Neurocardiogenic syncope is usually a self-limited episode of systemic hypotension characterized by both bradycardia (asystole or relative bradycardia) and peripheral vasodilation.[1][2]

Dual chamber pacing (DDD) is indicated only in patients with refractory neurocardiogenic syncope with significant bradycardia or asystole. In addition to cardiac pacing, adjunctive medical therapy may also be required as cardiac pacing alone has shown to be ineffective.

Indications

  • Refractory neurocardiogenic syncope with significant bradycardia or asystole.[3][4][5] Among patients with significant bradycardia, despite the successful demonstration of permanent pacers to increase time to first syncopal episode and to reduce recurrent episodes by the VASIS study [3] and the VPS study [5] respectively, the recent VPS-II study, did not demonstrate any reduction in the risk of recurrent syncopal events.[6] Therefore, the use of cardiac pacing in such patient population still remains controversial.
  • If cardiac pacing is indicated, dual chamber pacing is preferred following the demonstration of a strong positive tilt table test. Adjunctive medical therapy should be continued as it has shown to be more effective than pacing alone.

ACC/AHA Guidelines- Permanent Pacing in Hypersensitive Carotid Sinus Syndrome and Neurocardiogenic Syncope (DO NOT EDIT)[7]

Class I
"1. Permanent pacing is indicated for recurrent syncope caused by spontaneously occurring carotid sinus stimulation and carotid sinus pressure that induces ventricular asystole of more than 3 seconds. (Level of Evidence: C) "
Class IIa
"1. Permanent pacing is reasonable for syncope without clear, provocative events and with a hypersensitive cardioinhibitory response of 3 seconds or longer. (Level of Evidence: C) "
Class IIb
"1. Permanent pacing is reasonable for syncope without clear, provocative events and with a hypersensitive cardioinhibitory response of 3 seconds or longer. (Level of Evidence: B) "
Class III (No Benefit)
" 1. Permanent pacing is not indicated for a hypersensitive cardioinhibitory response to carotid sinus stimulation without symptoms or with vague symptoms. (Level of Evidence: C) "
" 2. Permanent pacing is not indicated for situational vasovagal syncope in which avoidance behavior is effective and preferred. (Level of Evidence: C) "

Guideline Resource

The ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities [7]

References

  1. ↑ Grubb BP (2005). "Neurocardiogenic syncope and related disorders of orthostatic intolerance". Circulation. 111 (22): 2997–3006. doi:10.1161/CIRCULATIONAHA.104.482018. PMID 15939833. Retrieved 2012-05-17. Unknown parameter |month= ignored (help)
  2. ↑ Benditt DG, Ferguson DW, Grubb BP, Kapoor WN, Kugler J, Lerman BB, Maloney JD, Raviele A, Ross B, Sutton R, Wolk MJ, Wood DL (1996). "Tilt table testing for assessing syncope. American College of Cardiology". Journal of the American College of Cardiology. 28 (1): 263–75. PMID 8752825. Retrieved 2012-05-17. Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 Sutton R, Brignole M, Menozzi C, Raviele A, Alboni P, Giani P, Moya A (2000). "Dual-chamber pacing in the treatment of neurally mediated tilt-positive cardioinhibitory syncope : pacemaker versus no therapy: a multicenter randomized study. The Vasovagal Syncope International Study (VASIS) Investigators". Circulation. 102 (3): 294–9. PMID 10899092. Retrieved 2012-05-17. Unknown parameter |month= ignored (help)
  4. ↑ Ammirati F, Colivicchi F, Santini M (2001). "Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope: a multicenter, randomized, controlled trial". Circulation. 104 (1): 52–7. PMID 11435337. Retrieved 2012-05-17. Unknown parameter |month= ignored (help)
  5. ↑ 5.0 5.1 Connolly SJ, Sheldon R, Roberts RS, Gent M (1999). "The North American Vasovagal Pacemaker Study (VPS). A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope". Journal of the American College of Cardiology. 33 (1): 16–20. PMID 9935002. Retrieved 2012-05-17. Unknown parameter |month= ignored (help)
  6. ↑ Connolly SJ, Sheldon R, Thorpe KE, Roberts RS, Ellenbogen KA, Wilkoff BL, Morillo C, Gent M (2003). "Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope: Second Vasovagal Pacemaker Study (VPS II): a randomized trial". JAMA : the Journal of the American Medical Association. 289 (17): 2224–9. doi:10.1001/jama.289.17.2224. PMID 12734133. Retrieved 2012-05-17. Unknown parameter |month= ignored (help)
  7. ↑ 7.0 7.1 Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW (2008). "ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons". Circulation. 117 (21): e350–408. doi:10.1161/CIRCUALTIONAHA.108.189742. PMID 18483207. Retrieved 2012-05-17. Unknown parameter |month= ignored (help)

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Neurocardiogenic_syncope_pacemaker_therapy&oldid=777740"