Incidence and Predictors of Syncope in Paced Patients with Sick Sinus Syndrome

In spite of a normal pacemaker/unction, syncope still occurs in some patients with sick sinus syndrome (SSSJ. Causes often remain unknown. To identify predictors and etiologies of this bothersome symptom, we studied 507 patients who received atrial, ventricular, and dual‐chamber pacemakers for SSS....

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Published in:Pacing and clinical electrophysiology 1992-11, Vol.15 (11), p.2055-2060
Main Authors: SGARBOSSA, ELENA B., PINSKI, SERGIO L., JAEGER, FREDRICK J., TROHMAN, RICHARD G., MALONEY, JAMES D.
Format: Article
Language:English
Subjects:
Actuarial Analysis
Aged
Cardiac Pacing, Artificial - methods
Electrocardiography, Ambulatory
Female
Follow-Up Studies
Humans
Incidence
Male
Pacemaker, Artificial
pacing
Risk Factors
sick sinus syndrome
Sick Sinus Syndrome - complications
Sick Sinus Syndrome - therapy
syncope
Syncope - epidemiology
Syncope - etiology
Time Factors
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Summary:In spite of a normal pacemaker/unction, syncope still occurs in some patients with sick sinus syndrome (SSSJ. Causes often remain unknown. To identify predictors and etiologies of this bothersome symptom, we studied 507 patients who received atrial, ventricular, and dual‐chamber pacemakers for SSS. During a mean follow‐up of 62 ± 38 months, actuarial incidence of syncope was 3% at 1 year, 8% at 5 years, and 13% at 10 years. Causes were vasovagal (18%), orthostatic hypotension (25.5%), rapid atrial tachyarrhythmias (11.5%), ventricular tachycardia (5%), acute myocardial ischemia (2.5%), and pacemaker/lead malfunction (6.5%), In 13 patients (29.5%), syncope remained unexplained. The only preimplant predictor for syncope was syncope as primary indication for pacemaker implant. Electrocardiographic correlation with bradycardia was not a predictor of relief of syncope during the follow‐up. In conclusion: (1) syncope in paced patients with SSS has multiple etiologies and may be multifactorial; (2) the only predictor of syncope after pacemaker implant is the occurrence of preimplant syncope as the main indication for pacing; (3) extensive Holier monitoring is not useful to document bradycardic origin of syncope nor to predict its recurrence; (4) SSS probably overlaps with other entities such as autonomic dysfunction, vasovagal syncope, carotid sinus hypersensitivity, and venous pooling, which would provide an explanation for recurrent syncope in patients with normal pacemaker function.
ISSN:0147-8389
1540-8159
DOI:10.1111/j.1540-8159.1992.tb03021.x