Predictors of pacemaker requirement in patients receiving implantable loop recorders for unexplained syncope: a systematic review and meta-analysis.

Syncope bradycardia heart block implantable loop recorder permanent pacemaker sinus node dysfunction

Journal

Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317

Informations de publication

Date de publication:
18 Mar 2024
Historique:
received: 12 02 2024
revised: 13 03 2024
accepted: 14 03 2024
medline: 21 3 2024
pubmed: 21 3 2024
entrez: 20 3 2024
Statut: aheadofprint

Résumé

Implantable loop recorders (ILR) are increasingly used to evaluate patients with unexplained syncope. Identification of all predictors of bradycardic syncope and consequent permanent pacemaker (PPM) insertion is of substantial clinical interest, as patients in the highest-risk category may benefit from upfront pacemaker insertion. We performed a systematic review and meta-analysis to identify risk predictors for PPM insertion in ILR recipients with unexplained syncope. An electronic database search (MEDLINE, Embase, Scopus, Cochrane) was performed in June 2023. Studies evaluating ILR recipients with unexplained syncope and recording risk factors for eventual PPM insertion were included. A random-effects model was used to calculate the pooled odds ratio (OR) for clinical and ECG characteristics with respect to future PPM requirement. 8 studies evaluating 1007 ILR recipients were included. 268 patients (26.6%) underwent PPM insertion during study follow-up. PPM recipients were older (mean age 70.2±15.4 vs 61.6±19.7 years, p<0.001). PR prolongation on baseline ECG was a significant predictor of PPM requirement (pooled OR 2.91, 95% confidence interval [CI] 1.63-5.20). The presence of distal conduction system disease, encompassing any bundle-branch or fascicular block, yielded a pooled OR of 2.88 for PPM insertion (CI 1.53-5.41). Injurious syncope and lack of syncopal prodrome were not significant predictors of PPM insertion. Sinus node dysfunction accounted for 62% of PPM insertions, while atrioventricular (AV) block accounted for 26%. Approximately one-quarter of ILR recipients for unexplained syncope require eventual PPM insertion. Advancing age, PR prolongation and distal conduction disease are the strongest predictors for PPM requirement.

Sections du résumé

BACKGROUND BACKGROUND
Implantable loop recorders (ILR) are increasingly used to evaluate patients with unexplained syncope. Identification of all predictors of bradycardic syncope and consequent permanent pacemaker (PPM) insertion is of substantial clinical interest, as patients in the highest-risk category may benefit from upfront pacemaker insertion.
OBJECTIVES OBJECTIVE
We performed a systematic review and meta-analysis to identify risk predictors for PPM insertion in ILR recipients with unexplained syncope.
METHODS METHODS
An electronic database search (MEDLINE, Embase, Scopus, Cochrane) was performed in June 2023. Studies evaluating ILR recipients with unexplained syncope and recording risk factors for eventual PPM insertion were included. A random-effects model was used to calculate the pooled odds ratio (OR) for clinical and ECG characteristics with respect to future PPM requirement.
RESULTS RESULTS
8 studies evaluating 1007 ILR recipients were included. 268 patients (26.6%) underwent PPM insertion during study follow-up. PPM recipients were older (mean age 70.2±15.4 vs 61.6±19.7 years, p<0.001). PR prolongation on baseline ECG was a significant predictor of PPM requirement (pooled OR 2.91, 95% confidence interval [CI] 1.63-5.20). The presence of distal conduction system disease, encompassing any bundle-branch or fascicular block, yielded a pooled OR of 2.88 for PPM insertion (CI 1.53-5.41). Injurious syncope and lack of syncopal prodrome were not significant predictors of PPM insertion. Sinus node dysfunction accounted for 62% of PPM insertions, while atrioventricular (AV) block accounted for 26%.
CONCLUSION CONCLUSIONS
Approximately one-quarter of ILR recipients for unexplained syncope require eventual PPM insertion. Advancing age, PR prolongation and distal conduction disease are the strongest predictors for PPM requirement.

Identifiants

DOI: 10.1016/j.hrthm.2024.03.038 PMID: 38508296
pubmed: 38508296
pii: S1547-5271(24)00284-4
doi: 10.1016/j.hrthm.2024.03.038
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Auteurs

Jeremy William (J)

The Alfred Hospital, Melbourne, Australia,; Monash University, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia.

Shane Nanayakkara (S)

The Alfred Hospital, Melbourne, Australia,; Monash University, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia.

David Chieng (D)

The Alfred Hospital, Melbourne, Australia,; The Baker Heart and Diabetes Research Institute, Melbourne, Australia.

Hariharan Sugumar (H)

The Alfred Hospital, Melbourne, Australia,; The Baker Heart and Diabetes Research Institute, Melbourne, Australia.

Liang-Han Ling (LH)

The Alfred Hospital, Melbourne, Australia,; The Baker Heart and Diabetes Research Institute, Melbourne, Australia.

Hitesh Patel (H)

The Alfred Hospital, Melbourne, Australia.

Justin Mariani (J)

The Alfred Hospital, Melbourne, Australia.

Sandeep Prabhu (S)

The Alfred Hospital, Melbourne, Australia,; The Baker Heart and Diabetes Research Institute, Melbourne, Australia.

Peter M Kistler (PM)

The Alfred Hospital, Melbourne, Australia,; Monash University, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia.

Aleksandr Voskoboinik (A)

The Alfred Hospital, Melbourne, Australia,; Monash University, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia. Electronic address: a.voskoboinik@alfred.org.au.

Classifications MeSH