Is DDD superior to VVI pacing in mixed carotid sinus syndrome? An acute and medium-term study

Pacing Clin Electrophysiol. 1988 Nov;11(11 Pt 2):1902-10. doi: 10.1111/j.1540-8159.1988.tb06327.x.


The aim of this study was to evaluate the importance of atrial synchronism for pacing therapy of patients with mixed carotid sinus syndrome. In 23 patients (21 m, two f; mean age 69 +/- 8 years) affected by symptomatic mixed carotid sinus syndrome we performed: (1) Research of ventriculo-atrial conduction, orthostatic hypotension and pacemaker effect; and (2) Carotid sinus massage in the standing position during VVI and DVI temporary pacing. Next, all patients received a permanent DDD pacemaker and entered a 2 month two period single-blind, randomized, cross-over study on DVI/DDD versus VVI mode. During the DVI/DDD period, no syncope occurred in any patients, minor symptoms persisted in 11 (48%) of them; during VVI period syncopes recurred in three patients, symptoms requiring the withdrawal of VVI pacing and premature DVI/DDD reprogramming in eight patients, minor symptoms in 17 (74%). A comparison between 14 patients, who preferred DVI/DDD period (Group A), and the remaining nine patients who noted no preference between DVI/DDD and VVI period (Group B) was performed on the basis of the preimplant evaluation. Group A patients had a greater pacemaker effect (-34 +/- 16 mmHg vs -16 +/- 14 mmHg) and a higher prevalence of symptomatic pacemaker effect (50% vs 0%), of ventriculo-atrial conduction (78% vs 44%) and of orthostatic hypotension (50% vs 11%), while the entity of the systolic pressure fall caused by carotid sinus massage was similar in the two groups either during VVI mode (Group A -51 +/- 16 mmHg vs Group B -56 +/- 27 mmHg) or DVI mode (Group A -38 +/- 17 mmHg vs Group B -45 +/- 17 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Cardiac Pacing, Artificial / methods*
  • Carotid Sinus / physiopathology*
  • Clinical Trials as Topic
  • Female
  • Follow-Up Studies
  • Humans
  • Hypotension, Orthostatic / etiology
  • Male
  • Pacemaker, Artificial*
  • Random Allocation
  • Reflex, Abnormal / complications
  • Reflex, Abnormal / therapy*
  • Syncope / etiology*
  • Syncope / therapy
  • Syndrome