Benefit of Dual-chamber Pacing With Closed Loop Stimulation (CLS) in Tilt-induced Cardioinhibitory Reflex Syncope

Inclusion criteria

Patients affected by clinical diagnosis of reflex syncope who meet all the following criteria:

• age >=40 years
• significant limitation of social and working life due to unpredictable or frequent syncope recurrences, ≥2 within the last year.
• type 2B cardio-inhibitory response to TT (according to the VASIS classification).
• Alternative therapies have failed or were not feasible.
• exclusion of other possible competitive causes of syncope.

Exclusion criteria

• Any other indication to IPG, implantable defibrillator (ICD), cardiac resynchronization therapy (CRT), according to current guidelines

Any cardiac dysfunctions possibly leading to loss of consciousness:

• overt heart failure;
• ejection fraction (LVEF) <40% (Echo-assessed within 3-month prior to study participation);
• myocardial infarction;
• diagnosis of hypertrophic or dilated cardiomyopathy;
• clinically significant valvular disease;
• sinus bradycardia <50 bpm or sinoatrial block;
• Mobitz I second-degree atrioventricular block;
• Mobitz II second or third-degree atrioventricular block;
• bundle-branch block;
• rapid paroxysmal supraventricular tachycardia or ventricular tachycardia;
• preexcited QRS complexes;
• prolonged QT interval;
• Brugada syndrome;
• arrhythmogenic right ventricular cardiomyopathy
• Symptomatic orthostatic hypotension diagnosed by standing BP measurement;
• Nonsyncopal loss of consciousness (eg, epilepsy, psychiatric, metabolic, drop-attack, cerebral transient ischemic attack, intoxication, cataplexy).
• Symptomatic cardioinhibitory carotid sinus hypersensitivity.