晕厥诊治进展演示文稿.pptVIP

CSS is a Class I indication for pacing (AHA and BPEG). Pacing therapy may be effective for CSS that is either Cardioinhibitory or Mixed cardioinhibitory/vasodepressor AV sequential pacing (DDD/DDI) is clearly preferable to ventricular demand (VVI) pacing. Wagshal AB, Wang SKS. Carotid sinus hypersensitivity. In: Syncope: Mechanisms and Management. Grubb BP, Olshansky B. eds. Armonk, NY: Futura;1998:281-295. Brignole M, Menozzi C. Carotid sinus syndrome: Diagnosis, natural history and treatment. Eur J C P E. 1992;4:247-254. The study was a randomized controlled trial, pacing versus no pacing, performed at the Royal Victoria Infirmary in Newcastle, between April 1998 and May 2000. Patients were followed for 12 months after randomization. The inclusion criteria were consecutive adults, over the age of 50 years, presenting with a non-accidental fall, who exhibited a positive response to CSM and who had no evidence of cognitive impairment or dementia. In patients with unexplained falls and a diagnosis of cardioinhibitory carotid sinus hypersensitivity, cardiac pacing reduced the total number of falls by 70%, total syncopal events by 53%, and total injurious events by 70%. There was a statistically significant reduction in the total number of falls among the pacemaker patient group, with a 70% reduction in total falls compared with the control group. Only 28 patients reported syncope; 22 syncopal events were reported by paced patients and 47 by controls. Although there was a 50% reduction in the overall number of syncopal episodes, this did not reach statistical significance. There was also a 70% reduction in the total number of injury events, from 202 in the control group to 61 in paced patients. Kenny RA, Richardson D, Steen N, et al. Carotid sinus syndrome: A modifiable risk factor for nonaccidental falls in older adults (SAFE PACE). J Am Coll Cardiol. 2001;38:1491-1496. The role of pacing therapy for the treatment of vasovagal syncope is controversial. So