Uso de marcapasos con sensor de asa cerrada en pacientes con síncope vasovagal refractario al tratamiento médico

Abstract

IntroductionPrevious studies have not found a clear benefit related to the use of pacemakers in cardioinhibitory syncopes; however, most of them were conducted with pacing systems using stimulation algorithms based in the abrupt drop of the heart rate. ObjetiveTo assess the impact of cardiac stimulation using a closed loop sensor pacemaker in the number of syncopes and its impact in the quality of life of patients with a vasovagal syncope refractory to medical treatment. MethodsProspective registration of patients diagnosed with vasovagal syncope refractory to medical treatment, who were implanted a bicameral closed loop sensor pacemaker between August 2008 and August 2013. Frequency of syncopal events and quality of life (using the SFSQ) were assessed before and after implanting the device. Results51 patients were included (27 women, 53%), with an average age of 52.98±16.88 and a follow-up of 20.19±14.64 months. 30 cases (58.8%) of cardioinhibitory syncope were registered, 20 (39.21%) were mixed and 1 (1.9%) was vasodepressor. The number of syncopes after the implantation of the closed loop sensor device was significantly reduced. Before the pacemaker was implanted, the total of registered syncopes was 198, a value that was reduced to 10 after the implantation (a 94.9% drop). Patients experienced 3.88±3.52 before the implantation, and they decreased to 0.19±0.63 episodes postimplant (p <0.001). Quality of life improved after the implantation: patient average SFSQ score before the implantation was of 70.19±24.5 vs. 15.88±13.73 postimplant (p=0.000). ConclusionImplanting a closed loop sensor pacemaker in patients with vasovagal syncope refractory to medical treatment revealed a significant decrease in the number of syncopes and an improvement in the quality of life.