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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EThe multicenter, prospective, observational SUP2 study demonstrates that algorithmic testing of patients with severe, recurrent, reflex syncope identifies appropriate candidates for cardiac pacing with a dual-chamber pacemaker. In addition, about half of patients had asystole; pacing in these patients reduced syncopal recurrence.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Esyncope\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiac pacing\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epacemaker\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ealgorithm\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Easystole\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Esyncopal recurrence\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESUP2\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENCT01509534\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine screening \u0026amp; prevention\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EConducting a testing algorithm of patients with severe, recurrent, unpredictable syncope to receive a dual-chamber (DDD) pacemaker provides clinical benefit by reducing syncopal recurrence. Michele Brignole, MD, Ospedali del Tigullio, Lavagna, Italy, presented data from the prospective, observational SUP2 trial [Brignole M et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E. 2015].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIt is not yet established whether cardiac pacing with an implanted DDD pacemaker is beneficial in patients with reflex syncope. The purpose of the SUP2 trial was to determine if DDD pacemaker implantation is effective in reducing recurrent reflex syncope in patients with severe, recurrent, unpredictable cardioinhibitory (CI) reflex syncope.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe primary end point was to evaluate the efficacy of the diagnostic algorithm by measuring the time to first syncopal recurrence. Patients were enrolled if they were aged \u0026gt;\u200540 years and had severe, recurrent, unpredictable syncopes, which included CI carotid sinus syncope (CSS), Vasovagal Syncope International Study (VASIS) 2B response, or type 1 asystole. The algorithm began with cardiac sinus massage to detect CSS; if negative, patients underwent tilt testing for VASIS 2B response, and if this was negative, patients received an implantable loop recorder (ILR) to detect asystole. Patients positive for any of the above received pacing; all other patients were followed clinically.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003ESevere syncope was defined as unpredictable with or without short (\u0026lt;\u200510 seconds) prodromes that affected quality of life. Recurrent syncope was defined as \u2265\u20052 episodes within the past year or \u2265\u20053 episodes during the past 2 years. Suspected reflex syncope was defined as reflex syncope without severe structural heart disease, severe abnormalities, rhythm disturbances, orthostatic hypotension, and nonsyncopal causes of transient loss of consciousness.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAfter algorithm testing, 66 of 253 had CI CSS, 34 of the remaining 185 had a VASIS 2B response, and 25 of the remaining 134 had type 1 asystole, all of whom received a DDD pacemaker. Thus, in total, 125 out of 253 patients (47%) finally received a pacemaker. Among those who did not receive a pacemaker, 10 were lost to follow-up, 82 were ongoing with clinical observation, 4 had tachyarrhythmia, and 13 had no rhythm variations. At baseline, the mean age was 70 years, mean age of first syncope was 61 years, and the proportion of syncopes without or with prodromes \u0026lt;\u200510 seconds was 89%.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EDDD pacemaker implantation was associated with significantly greater survival rates compared with patients who received only an ILR (15% vs 37% at 24 months; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.004). DDD was not particularly more efficacious in any specific indication subgroup.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EProf Brignole highlighted that the data suggest that about 50% of patients with severe recurrent syncope have an asystolic reflex, and pacing resulted in a low recurrence rate. In conclusion, the SUP2 trial data indicate that using a testing algorithm to select patients who are candidates for pacing is feasible and provides clinical benefit.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/22\/7.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzl3eq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}