Abstract:
OBJECTIVES:To determine, using systematic review of the biomedical literature, whether pacing reduces risk of recurrent syncope and relevant clinical outcomes among adult patients with reflex-mediated syncope. METHODS:MEDLINE (through PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials (through October 7, 2015) were searched for randomized trials and observational studies examining pacing and syncope, and the bibliographies of known systematic reviews were also examined. Studies were rejected for poor-quality study methods and for the lack of the population, intervention, comparator, or outcome(s) of interest. RESULTS:Of 3188 citations reviewed, 10 studies met the inclusion criteria for systematic review, including a total of 676 patients. These included 9 randomized trials and 1 observational study. Of the 10 studies, 4 addressed patients with carotid sinus hypersensitivity, and the remaining 6 addressed vasovagal syncope. Among the 6 open-label (unblinded) studies, we found that pacing was associated with a 70% reduction in recurrent syncope (relative risk [RR]: 0.30; 95% confidence interval [CI]: 0.15-0.60). When the 2 analyzable studies with double-blinded methodology were considered separately, there was no clear benefit (RR: 0.73; 95% CI: 0.25-2.1), but confidence intervals were wide. The strongest evidence was from the randomized, double-blinded ISSUE-3 (Third International Study on Syncope of Uncertain Etiology) trial, which demonstrated a benefit of pacing among patients with recurrent syncope and asystole documented by implantable loop recorder. CONCLUSIONS:There are limited data with substantive evidence of outcome ascertainment bias, and only 2 studies with a double-blinded study design have been conducted. The evidence does not support the use of pacing for reflex-mediated syncope beyond patients with recurrent vasovagal syncope and asystole documented by implantable loop recorder.
journal_name
Circulationjournal_title
Circulationauthors
Varosy PD,Chen LY,Miller AL,Noseworthy PA,Slotwiner DJ,Thiruganasambandamoorthy Vdoi
10.1161/CIR.0000000000000500subject
Has Abstractpub_date
2017-08-01 00:00:00pages
e123-e135issue
5eissn
0009-7322issn
1524-4539pii
CIR.0000000000000500journal_volume
136pub_type
杂志文章,meta分析,评审相关文献
CIRCULATION文献大全abstract:BACKGROUND:Randomized clinical trials have shown that multivessel coronary angioplasty is feasible and provides similar long-term survival as bypass surgery in selected patients. However, the higher need for repeat intervention, in particular, coronary artery bypass graft surgery, remains a problem. The objective of th...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.96.11.3873
更新日期:1997-12-02 00:00:00
abstract:BACKGROUND:Women receive less evidence-based medical care than men and have higher rates of death after acute myocardial infarction (AMI). It is unclear whether efforts undertaken to improve AMI care have mitigated these sex disparities in the current era. METHODS AND RESULTS:Using the Get With the Guidelines-Coronary...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.108.789800
更新日期:2008-12-16 00:00:00
abstract:BACKGROUND:Both thallium imaging and low-dose dobutamine echocardiography have been proposed to predict the reversibility of left ventricular (LV) dysfunction in patients with coronary disease. The present study was designed to evaluate whether the use of these techniques during the preoperative assessment of coronary ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.92.9.37
更新日期:1995-11-01 00:00:00
abstract::The widespread use of exercise testing for the detection of myocardial ischemia in patients suspected of having coronary artery disease led to the detection of ischemic changes in many subjects who subsequently were found to have angiographically normal epicardial vessels--the false positive response. Such a result is...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1991-05-01 00:00:00
abstract:BACKGROUND:Calcineurin is a calcium-regulated phosphatase that plays a major role in cardiac hypertrophy. We previously described that alternative splicing of the calcineurin Aβ (CnAβ) gene generates the CnAβ1 isoform, with a unique C-terminal region that is different from the autoinhibitory domain present in all other...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.110.012211
更新日期:2011-06-21 00:00:00
abstract:BACKGROUND:High-mobility group box-1 (HMGB1) is a nuclear factor released by necrotic cells and by activated immune cells. HMGB1 signals via members of the toll-like receptor family and the receptor for advanced glycation end products (RAGE). Although HMGB1 has been implicated in ischemia/reperfusion (I/R) injury of th...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.108.769331
更新日期:2008-06-24 00:00:00
abstract:BACKGROUND:Coronary artery bypass surgery (CABG) has been associated with a range of neurological and neuropsychological complications from stroke to cognitive problems such as memory and problem solving disturbance. However, little is known about the impact of percutaneous coronary intervention (PCI) on neuropsycholog...
journal_title:Circulation
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1161/01.CIR.0000148366.80443.2B
更新日期:2004-11-30 00:00:00
abstract:BACKGROUND:Household air pollution is the third largest risk factor for global disease burden, but direct links with cardiovascular disease mortality are limited. This study aimed to evaluate the relationship between household fuel use and cardiovascular disease mortality. METHODS AND RESULTS:The Golestan Cohort Study...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.115.020288
更新日期:2016-06-14 00:00:00
abstract:BACKGROUND:Endothelial progenitor cells (EPCs) circulate in adult peripheral blood (PB) and contribute to neovascularization. However, little is known regarding whether EPCs and their putative precursor, CD34-positive mononuclear cells (MNC(CD34+)), are mobilized into PB in acute ischemic events in humans. METHODS AND...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/hc2301.092122
更新日期:2001-06-12 00:00:00
abstract:BACKGROUND:Myocardial perfusion reflects the macro- and microvascular coronary circulation. Recent quantitation developments using cardiovascular magnetic resonance perfusion permit automated measurement clinically. We explored the prognostic significance of stress myocardial blood flow (MBF) and myocardial perfusion r...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.119.044666
更新日期:2020-04-21 00:00:00
abstract:BACKGROUND:In the preterm newborn, a patent ductus arteriosus is in large part a result of the increased sensitivity of the immature ductus to prostaglandin E2 (PGE2). PGE2 acts through 3 G protein-coupled receptors (EP2, EP3, and EP4) that activate both adenyl cyclase and K(ATP) channels. We explored these pathways to...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000145159.16637.5D
更新日期:2004-10-19 00:00:00
abstract:BACKGROUND:The effect of the increasing prevalence of obesity on blood pressure (BP) secular trends is unclear. We analyzed BP and body mass index secular trends between 1998 and 2006 in children and adolescents of the Seychelles, a rapidly developing island state in the African region. METHODS AND RESULTS:School-base...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.108.796276
更新日期:2009-02-03 00:00:00
abstract:BACKGROUND:Endothelial nitric oxide (NO)-mediated responses are impaired in arterioles of male spontaneously hypertensive rats (SHR), but they are still present in female SHR. We hypothesized that in vitro incubation of arterioles of male SHR with estrogen will restore NO-mediated responses by upregulation of endotheli...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.101.1.94
更新日期:2000-01-04 00:00:00
abstract:BACKGROUND:In patients with mitral stenosis, reduced cardiac output or altered pulmonary hemodynamics may increase sympathetic nerve activity. However, the magnitude of the increase in sympathetic activity in such patients and the effect of valvuloplasty on this activity are unknown. METHODS AND RESULTS:We microneurog...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.96.10.3443
更新日期:1997-11-18 00:00:00
abstract:BACKGROUND:Adrenergic activation is thought to be an important determinant of outcome in subjects with chronic heart failure (CHF), but baseline or serial changes in adrenergic activity have not been previously investigated in a large patient sample treated with a powerful antiadrenergic agent. METHODS AND RESULTS:Sys...
journal_title:Circulation
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1161/01.CIR.0000141297.50027.A4
更新日期:2004-09-14 00:00:00
abstract::Current automatic implantable cardioverter-defibrillators detect tachyarrhythmias primarily by rate-only algorithms and cannot adequately distinguish hemodynamically stable from unstable tachyarrhythmias. The responses of right atrial (mean) and right ventricular pressures (mean, systolic, diastolic, and pulse) to 64 ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.82.2.394
更新日期:1990-08-01 00:00:00
abstract:BACKGROUND:Diabetes mellitus is a predictor of morbidity and mortality in patients with heart failure. The effect of angiotensin-converting enzyme (ACE) inhibitors on the prevention of diabetes in patients with left ventricular dysfunction is unknown. The aim of this retrospective study was to assess the effect of the ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.0000054611.89228.92
更新日期:2003-03-11 00:00:00
abstract:BACKGROUND:The mechanisms by which replacement hormones may reduce the risk of coronary heart disease are not fully understood. Of specific interest is a potential effect of replacement hormones on plasma fibrinolytic activity, a putative determinant of thrombotic events. METHODS AND RESULTS:We investigated the relati...
journal_title:Circulation
pub_type: 杂志文章,多中心研究
doi:10.1161/01.cir.93.11.1970
更新日期:1996-06-01 00:00:00
abstract:BACKGROUND:Increased common carotid artery intima-media thickness (CCA-IMT) is a marker of early atherosclerosis. Low-grade inflammation is associated with the pathogenesis of atherosclerosis. Low-grade inflammation and increased CCA-IMT are observed in end-stage renal disease (ESRD). Oxidative stress is involved in ur...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.0000035250.66458.67
更新日期:2002-10-22 00:00:00
abstract::For estimating left ventricular mass (LVM), ECG criteria for left ventricular hypertrophy (LVH) were selected from conventional 12-lead ECGs, orthogonal three-lead ECGs, and multiple-dipole ECGs (MDECG). The three cardiograms were recorded in 139 patients for whom the degree of LVH was independently determined from bi...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.60.6.1350
更新日期:1979-12-01 00:00:00
abstract::Calcification of valvular bioprostheses in children is a major problem that has stimulated extensive research in our laboratory. In previous reports, we have shown that the rate of calcification could be reduced by decreasing the phosphate content in the tissue or by blocking calcification binding sites with Mg++ and/...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1984-09-01 00:00:00
abstract:BACKGROUND:The relations of insulin sensitivity (IS) to hypertension incidence may vary according to baseline age, body mass index (BMI), and blood pressure (BP). METHODS AND RESULTS:We investigated the relations of IS (insulin sensitivity index, ISI(0,120)) to 4-year incidence of hypertension and BP progression in 19...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.105.535039
更新日期:2005-09-20 00:00:00
abstract:BACKGROUND:To identify patients at risk for postoperative myocardial injury and death, measuring cardiac troponin routinely after noncardiac surgery has been suggested. Such monitoring was implemented in our hospital. The aim of this study was to determine the predictive value of postoperative myocardial injury, as mea...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/CIRCULATIONAHA.113.002128
更新日期:2013-06-11 00:00:00
abstract:BACKGROUND:The suggestion that increased QT dispersion (QTD) is due to increased differences in local action potential durations within the myocardium is wanting. An alternative explanation was sought by relating QTD to vectorcardiographic T-loop morphology. METHODS AND RESULTS:The T loop is characterized by its ampli...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.99.11.1458
更新日期:1999-03-23 00:00:00
abstract:BACKGROUND:Cardiac growth and function may be modulated in part by trophic effects of neurohormones. Specifically, aldosterone has been shown to stimulate the growth of cardiac myocytes and the accumulation of cardiac extracellular matrix proteins. Moreover, a variant of the aldosterone synthase gene (a cytosine/thymid...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.99.17.2255
更新日期:1999-05-04 00:00:00
abstract:BACKGROUND:Human endothelial and vascular smooth muscle cells synthesize prostanoids. Several of these have been implicated in the physiological and pathophysiological regulation of vascular tone; however, there is no direct evidence that human blood vessels synthesize sufficient prostanoid to alter vessel tone. METHO...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.92.8.2113
更新日期:1995-10-15 00:00:00
abstract::Physiological studies of the type we have described, when performed in patients with the WPW syndrome, can yield diagnostic information regarding the mechanism of arrhythmia, demonstrate functional properties of therapeutic import, facilitate therapeutic decision-making about drug regimens and presumptively localize t...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.51.5.767
更新日期:1975-05-01 00:00:00
abstract:BACKGROUND:Observational studies have identified an association between body mass index (BMI) and incident atrial fibrillation (AF). Inferring causality from observational studies, however, is subject to residual confounding, reverse causation, and bias. The primary objective of this study was to evaluate the causal as...
journal_title:Circulation
pub_type: 杂志文章,meta分析
doi:10.1161/CIRCULATIONAHA.116.024921
更新日期:2017-02-21 00:00:00
abstract:BACKGROUND:Human salusins, related bioactive polypeptides with mitogenic effects on vascular smooth muscle cells and fibroblasts and roles in hemodynamic homeostasis, may be involved in the origin of coronary atherosclerosis. Macrophage foam cell formation, characterized by cholesterol ester accumulation, is modulated ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.107.712539
更新日期:2008-02-05 00:00:00
abstract:BACKGROUND:Precise knowledge of the expected "normal" lumen diameter at a given coronary anatomic location is a first step toward developing a quantitative estimate of coronary disease severity that could be more useful than the traditional "percent stenosis." METHODS AND RESULTS:Eighty-three arteriograms were careful...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.86.1.232
更新日期:1992-07-01 00:00:00