Impact of dual-chamber pacing with closed loop stimulation on quality of life in patients with recurrent reflex vasovagal syncope: results of the SPAIN study

• Published in: Europace (London, England) Vol. 22; no. 2; pp. 314 - 319
• Main Authors: Barón-Esquivias, Gonzalo, Moya-Mitjans, Angel, Martinez-Alday, Jesús, Ruiz-Granell, Ricardo, Lacunza-Ruiz, Javier, Garcia-Civera, Roberto, Gutiérrez-Carretero, Encarnación, Romero-Garrido, Rafael, Morillo, Carlos A
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.02.2020
• Subjects: Closed loop stimulation; Vasovagal syncope; Quality of life; SF-36
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euz294

Abstract Aims  Reflex vasovagal syncope (VVS) is the most common cause of syncope and patients with recurrent episodes may severely impair quality of life (QoL). This pre-specified analysis evaluated whether the clinically significant reduction in syncope burden demonstrated by dual-chamber pacing with closed loop stimulation (DDD-CLS) reported in the SPAIN trial translates into improved QoL. Methods and results Patients aged ≥40 years with ≥5 VVS episodes and cardioinhibitory response induced by head-up tilt testing were included. Patients were randomized 1:1 to active DDD-CLS pacing algorithm for 12 months followed by sham DDI mode for the remaining 12 months (Group A) or vice versa (Group B). QoL was assessed using the Short Form-36 (SF-36) health survey, Physical Component Score (PCS), and Mental Component Score (MCS) before randomization (baseline) and at 12- and 24-month follow-up. Fifty-four patients were enrolled from 11 participating centres. No significant carryover effect was detected for any variable, and the only period effect was observed in the vitality subdomain (P = 0.033). Mean SF-36 scores were higher in the DDD-CLS group vs. the DDI group for the eight subdomains and significantly different in physical role, bodily pain, and vitality (P < 0.05). The analysis of component summary scores indicated that DDD-CLS benefited both mental and physical components with significant differences in PCS when compared with the DDI group. Conclusion Dual-chamber pacing with closed loop stimulation determined a significant and clinically relevant improvement in QoL across both mental and physical components in patients with recurrent VVS. Registration Closed Loop Stimulation for Neuromediated Syncope (SPAIN Study); NCT01621464.