Impact of dual-chamber pacing with closed loop stimulation on quality of life in patients with recurrent reflex vasovagal syncope: results of the SPAIN study.

Aims: Reflex vasovagal syncope (VVS) is the most common cause of syncope and patients with recurrent episodes may severely impair quality of life (QoL). This pre-specified analysis evaluated whether the clinically significant reduction in syncope burden demonstrated by dual-chamber pacing with closed loop stimulation (DDD-CLS) reported in the SPAIN trial translates into improved QoL.

Methods And Results: Patients aged ≥40 years with ≥5 VVS episodes and cardioinhibitory response induced by head-up tilt testing were included.

Dual-Chamber Pacing With Closed Loop Stimulation in Recurrent Reflex Vasovagal Syncope: The SPAIN Study.

Background: Pacing in vasovagal syncope remains controversial.

Objectives: The authors evaluated dual-chamber pacing with closed loop stimulation (DDD-CLS) in patients with cardioinhibitory vasovagal syncope.

Methods: This randomized, double-blind, controlled study included Canadian and Spanish patients age ≥40 years, with high burden syncope (≥5 episodes, ≥2 episodes in the past year), and a cardioinhibitory head-up tilt test (bradycardia <40 beats/min for 10 s or asystole >3 s).

Prognostic value of the electrocardiogram in patients with syncope: data from the group for syncope study in the emergency room (GESINUR).

Background: The Group for Syncope Study in the Emergency Room (GESINUR) was a Spanish multicenter, prospective, observational study that evaluated the clinical presentation and acute management of loss of consciousness in Spain. Several studies have shown that an abnormal ECG is a poor prognostic factor in patients with syncope. However, the prognostic significance of each ECG abnormality is not well known.

Medium-term results of cryoballoon ablation of the pulmonary veins in patients with paroxysmal and persistent atrial fibrillation. First experience of a Spanish center.

Purpose: Cryoballoon ablation of the pulmonary veins (CAPV) is a new technique that could have similar results to radiofrequency procedures, but with fewer complications. We analyzed the outcomes and safety of this technique in a consecutive cohort of patients with atrial fibrillation (AF).

Methods: A total of 63 patients with paroxysmal (n = 40) or persistent (n = 23) AF were studied.

Outcome of patients with syncope beyond the implantable loop recorder.

Aims: The implantation of an implantable loop recorder (ILR) leads to the diagnosis in about 35% of patients with syncope of unknown origin. Information on outcome of patients in whom a diagnosis is not reached during the lifetime of the device is scarce. The aim of our study is to determine the outcome of these patients in terms of syncope recurrence and survival.

Ablation or conservative management of electrical storm due to monomorphic ventricular tachycardia: differences in outcome.

Aims: Electrical storm (ES) is a life-threatening condition that predicts bad prognosis. Treatment includes antiarrhythmic drugs (AAD) and catheter ablation (CA). The present study aims to retrospectively compare prognosis in terms of survival and ES recurrence in 52 consecutive patients experiencing a first ES episode.

Diagnosis, management, and outcomes of patients with syncope and bundle branch block.

Aims: Although patients with syncope and bundle branch block (BBB) are at high risk of developing atrio-ventricular block, syncope may be due to other aetiologies. We performed a prospective, observational study of the clinical outcomes of patients with syncope and BBB following a systematic diagnostic approach.

Methods And Results: Patients with ≥1 syncope in the last 6 months, with QRS duration ≥120 ms, were prospectively studied following a three-phase diagnostic strategy: Phase I, initial evaluation; Phase II, electrophysiological study (EPS); and Phase III, insertion of an implantable loop recorder (ILR).

Syncope and bundle branch block. Diagnostic yield of a stepped use of electrophysiology study and implantable loop recorders.

Introduction And Objectives: The objective of this study was to determine the diagnostic yield of a stepped protocol involving an electrophysiologic study (EPS) and implantable loop recorders (ILR) in patients with syncope and bundle branch block (BBB).

Methods: Eighty-five consecutive patients referred for syncope and BBB after initial non-diagnostic assessment underwent EPS including a pharmacological challenge with procainamide. Those patients without indication for defibrillator implantation received ILRs.

Epidemiological characteristics and diagnostic approach in patients admitted to the emergency room for transient loss of consciousness: Group for Syncope Study in the Emergency Room (GESINUR) study.

Aims: To assess the clinical presentation and acute management of patients with transient loss of consciousness (T-LOC) in the emergency department (ED).

Methods And Results: A multi-centre prospective observational study was carried out in 19 Spanish hospitals over 1 month. The patients included were > or =14 years old and were admitted to the ED because of an episode of T-LOC.

Reproducibility of electrocardiographic findings in patients with suspected reflex neurally-mediated syncope.

The reproducibility of electrocardiographic (ECG) recordings in syncopal recurrences and the diagnostic role of nonsyncopal arrhythmias are not well known. The objective of this study was to analyse the reproducibility of the ECG findings recorded with implantable loop recorders in 41 patients with suspected neurally-mediated syncope who were included in the International Study on Syncope of Uncertain Origin-2 study and that had > or =2 events recorded by implantable loop recorders. In these patients, the electrocardiogram obtained with the first documented syncope (index syncope) was compared with other recorded events.

Implantation of single-lead atrioventricular permanent pacemakers guided by electroanatomic navigation without the use of fluoroscopy.

Aims: Fluoroscopy is the standard and almost unique tool used for cardiac imaging during permanent pacemaker implantation, and its use implies exposure of patients and operators to radiation. The usefulness for this purpose of electroanatomic systems not based on fluoroscopy is unknown. Our aim was to study the feasibility of implanting single-lead VDD pacemakers without the use of fluoroscopy.

[Therapeutic success of a prospective cardioversion protocol for persistent atrial fibrillation].

Introduction And Objectives: The best therapeutic approach for persistent atrial fibrillation has yet to be defined. Our aim was to investigate the effects of cardioversion in unselected patients with persistent atrial fibrillation who were treated according to a strict protocol involving pretreatment, cardioversion, and follow-up.

Methods: Consecutive patients with persistent atrial fibrillation of at least 1 months' duration were included prospectively in a cardioversion protocol that involved standard antiarrhythmic pretreatment, with amiodarone being offered first, and follow-up.

Syncopal monomorphic ventricular tachycardia with pleomorphism, sensitive to antitachycardia pacing in a patient with Brugada syndrome.

Polymorphic ventricular tachycardia and ventricular fibrillation are the most common arrhythmias in Brugada syndrome, causing syncope or sudden death. Sustained monomorphic ventricular tachycardias are rare in this context. We report the case of a 41-year-old man with repetitive syncopal episodes and an ajmaline-induced characteristic Brugada ECG pattern, in whom episodes of monomorphic ventricular tachycardia with pleomorphism and response to ventricular pacing were documented.

Effectiveness of physical counterpressure maneuvers in preventing vasovagal syncope: the Physical Counterpressure Manoeuvres Trial (PC-Trial).

Objectives: In this study, we assessed the effectiveness of physical counterpressure maneuvers (PCM) in daily life.

Background: There is presently no evidence-based therapy for vasovagal syncope. Current treatment consists of explanation and life-style advice.

Lack of correlation between the responses to tilt testing and adenosine triphosphate test and the mechanism of spontaneous neurally mediated syncope.

Aims: We prospectively correlated the results of tilt testing (TT) and adenosine triphosphate test (ATP) with the findings observed during a spontaneous syncopal relapse by means of an implantable loop recorder (ILR) in patients with a clinical diagnosis of neurally mediated syncope.

Methods And Results: We included patients with three or more clinically severe syncopal episodes in the last 2 years without significant electrocardiographic and cardiac abnormalities. Patients with orthostatic hypotension and carotid sinus syncope were excluded.

Early application of an implantable loop recorder allows effective specific therapy in patients with recurrent suspected neurally mediated syncope.

Aims: This prospective multicentre observational study assessed the efficacy of specific therapy based on implantable loop recorder (ILR) diagnostic observations in patients with recurrent suspected neurally mediated syncope (NMS).

Methods And Results: Patients with three or more clinically severe syncopal episodes in the last 2 years without significant electrocardiographic and cardiac abnormalities were included. Orthostatic hypotension and carotid sinus syncope were excluded.

Significance of tilt table testing in patients with suspected arrhythmic syncope and negative electrophysiologic study.

Background: The diagnostic significance of a tilt table test (TTT) in patients with a suspected arrhythmic etiology for syncope and negative electrophysiologic study (EPS) has not been previously assessed comparing the TTT results with the findings of prolonged monitoring using an implantable loop recorder (ILR). We sought to assess the diagnostic yielding of TTT in patients with suspected arrhythmic syncope and negative EPS.

Methods And Results: In 81 patients with suspected arrhythmic etiology for syncope and negative EPS, TTT was performed and an ILR implanted regardless the results of TTT.

Atrioventricular node ablation and permanent ventricular pacemaker implantation without fluoroscopy: use of an electroanatomic navigation system.

Non-fluoroscopy AV ablation and pacemaker implantation. Fluoroscopic guidance is the standard tool used for transvenous pacemaker implantations and for electrophysiological and ablation procedures. It implies X-ray exposure, occasionally with high dose of radiation for the patient and operator.

Proposed electrocardiographic classification of spontaneous syncope documented by an implantable loop recorder.

Uniform data from the literature show that the mechanism of syncope recorded by implantable loop recorder is extremely heterogeneous and a wide variety of rhythm disturbances is recorded at the time of syncope. Therefore, the proposed classification aims to group the observations into homogeneous patterns in order to define an acceptable standard useful for future studies and clinical practice.

Selective use of diagnostic tests inpatients with syncope of unknown cause.

Objective: We sought to prospectively assess the diagnostic yielding of a protocol in which electrophysiologic studies (EPS), tilt-table tests (TTTs), and loop recorder implantation are selectively used.

Background: The optimal strategy in the diagnosis of patients with syncope of unknown cause has not been defined.

Methods: A total of 184 consecutive patients with syncope of unknown cause were classified into two groups.

Mechanism of syncope in patients with heart disease and negative electrophysiologic test.

Background: In patients with syncope and structural heart disease, syncope is suspected to be attributable to a primary cardiac arrhythmia, but little is known of its mechanism when electrophysiologic study is unremarkable.

Methods And Results: We applied an implantable loop recorder in 35 patients with overt heart disease at risk of ventricular arrhythmia, because these were patients with previous myocardial infarction or cardiomyopathy with depressed ejection fraction or nonsustained ventricular tachycardia in whom an electrophysiologic study was unremarkable. During a follow-up of 3 to 15 months, syncope recurred in 6 patients (17%) after a mean of 6+/-5 months; in 3 patients, the mechanism of syncope was bradycardia with long pauses (sudden-onset AV block in 2 cases and sinus arrest in 1 case); in 1 patient, there was stable sinus tachycardia; and in 2 patients, who had chronic atrial fibrillation, there was an increase in ventricular rate.