Syncope: DDD-pacing controlled symptoms better than VVI-pacing

Clinical bottom line (level 1b)

  1. Patients who had a pacemaker inserted for carotid sinus syndrome were more likely to be free of symptoms using DDD-pacing compared with VVI-pacing (NNT = 2 at 2 months) .
Brignole et al: Pacing and Clinical Electrophysiology 1991; 14 (1): 196-203
Expires October 2003

The study

Single-blinded ?concealed randomised cross-over trial ?with intention-to-treat
Setting: cardiology units in 2 acute hospitals, Italy

26 patients (aged mean 69, 73% male) with severe and recurrent syncope reproduced by carotid sinus massage, who had a DDD pacemaker inserted.

Excluded if
  • other cause of syncope possible


    • Control Group: (n = 26, 26 analysed): ventricular inhibited pacing
    Experimental Group: (n = 26, 26 analysed): dual chamber pacing

    100% followed for 2 months
    Outcome notes:
    • any symptom : syncope, dizziness, heart failure

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    any symptom weeks 19
    (73.1%)    		 8
    (30.8%)    		 58%
    (22% to 77%)    		 42.3%
    (17.7% to 66.9%)    		 2
    (1 to 6)

    Citation

    1. Brignole M, Menozzi C, Lolli G, et al: . Pacing and Clinical Electrophysiology 1991; 14 (1): 196-203
    Contributor: Chris Ball and Clare Wotton, October 1999
    Reviewer:

    Clinical Question.
    Patient carotid sinus syndrome, syncope
    Intervention or Exposure DDD-pacing
    Comparison VVI pacing
    Outcome symptoms