Skip to main content
PMC home page
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 1997 Jul;73(861):415–418. doi: 10.1136/pgmj.73.861.415

Permanent cardiac pacing in elderly patients with recurrent falls, dizziness and syncope, and a hypersensitive cardioinhibitory reflex.

J G Crilley 1, B Herd 1, C S Khurana 1, C A Appleby 1, M A de Belder 1, A Davies 1, J A Hall 1
PMCID: PMC2431415  PMID: 9338027

Abstract

The study was designed to assess the outcome of treatment with permanent dual-chamber pacing of elderly patients with falls, dizziness and syncope associated with the demonstration of a hypersensitive cardioinhibitory reflex. Questionnaires were sent to patients (and their general practitioners) who had been referred to a regional pacing centre with recurrent falls, dizziness or syncope diagnosed as likely to be secondary to cardioinhibitory carotid sinus syndrome or predominantly cardioinhibitory vasovagal syndrome. After pacemaker insertion, 84% of patients had no further syncope over a mean follow-up period of 10 (range 1.5 to 30) months. Minor symptoms persisted in only 40% of all patients. Symptoms were unchanged in 22%. It was concluded that permanent dual-chamber pacing is an effective treatment for elderly patients with recurrent falls, dizziness and syncope in whom a hypersensitive cardioinhibitory reflex is found. Good results were obtained in this group with a simple diagnostic work-up.

Full text

PDF
415

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brignole M., Menozzi C., Lolli G., Bottoni N., Gaggioli G. Long-term outcome of paced and nonpaced patients with severe carotid sinus syndrome. Am J Cardiol. 1992 Apr 15;69(12):1039–1043. doi: 10.1016/0002-9149(92)90860-2. [DOI] [PubMed] [Google Scholar]
  2. Brignole M., Menozzi C., Lolli G., Oddone D., Gianfranchi L., Bertulla A. Validation of a method for choice of pacing mode in carotid sinus syndrome with or without sinus bradycardia. Pacing Clin Electrophysiol. 1991 Feb;14(2 Pt 1):196–203. doi: 10.1111/j.1540-8159.1991.tb05090.x. [DOI] [PubMed] [Google Scholar]
  3. Brown K. A., Maloney J. D., Smith C. H., Haritzler G. O., Ilstrup D. M. Carotid sinus reflex in patients undergoing coronary angiography: relationship of degree and location of coronary artery disease to response to carotid sinus massage. Circulation. 1980 Oct;62(4):697–703. doi: 10.1161/01.cir.62.4.697. [DOI] [PubMed] [Google Scholar]
  4. Davis T. L., Freemon F. R. Electroencephalography should not be routine in the evaluation of syncope in adults. Arch Intern Med. 1990 Oct;150(10):2027–2029. [PubMed] [Google Scholar]
  5. Fitzpatrick A., Theodorakis G., Ahmed R., Williams T., Sutton R. Dual chamber pacing aborts vasovagal syncope induced by head-up 60 degrees tilt. Pacing Clin Electrophysiol. 1991 Jan;14(1):13–19. doi: 10.1111/j.1540-8159.1991.tb04042.x. [DOI] [PubMed] [Google Scholar]
  6. Hale W. A., Delaney M. J., McGaghie W. C. Characteristics and predictors of falls in elderly patients. J Fam Pract. 1992 May;34(5):577–581. [PubMed] [Google Scholar]
  7. Kapoor W. N. Diagnostic evaluation of syncope. Am J Med. 1991 Jan;90(1):91–106. doi: 10.1016/0002-9343(91)90511-u. [DOI] [PubMed] [Google Scholar]
  8. Kapoor W. N. Syncope in older persons. J Am Geriatr Soc. 1994 Apr;42(4):426–436. doi: 10.1111/j.1532-5415.1994.tb07493.x. [DOI] [PubMed] [Google Scholar]
  9. Lipsitz L. A., Wei J. Y., Rowe J. W. Syncope in an elderly, institutionalised population: prevalence, incidence, and associated risk. Q J Med. 1985 Apr;55(216):45–54. [PubMed] [Google Scholar]
  10. McIntosh S. J., Lawson J., Kenny R. A. Clinical characteristics of vasodepressor, cardioinhibitory, and mixed carotid sinus syndrome in the elderly. Am J Med. 1993 Aug;95(2):203–208. doi: 10.1016/0002-9343(93)90261-m. [DOI] [PubMed] [Google Scholar]
  11. McIntosh S., Da Costa D., Kenny R. A. Outcome of an integrated approach to the investigation of dizziness, falls and syncope in elderly patients referred to a 'syncope' clinic. Age Ageing. 1993 Jan;22(1):53–58. doi: 10.1093/ageing/22.1.53. [DOI] [PubMed] [Google Scholar]
  12. Naylor R., Rosin A. J. Falling as a cause of admission to a geriatric unit. Practitioner. 1970 Sep;205(227):327–330. [PubMed] [Google Scholar]
  13. Rubenstein L. Z., Robbins A. S., Josephson K. R., Schulman B. L., Osterweil D. The value of assessing falls in an elderly population. A randomized clinical trial. Ann Intern Med. 1990 Aug 15;113(4):308–316. doi: 10.7326/0003-4819-113-4-308. [DOI] [PubMed] [Google Scholar]
  14. Sudarsky L. Geriatrics: gait disorders in the elderly. N Engl J Med. 1990 May 17;322(20):1441–1446. doi: 10.1056/NEJM199005173222007. [DOI] [PubMed] [Google Scholar]
  15. Tinetti M. E., Baker D. I., McAvay G., Claus E. B., Garrett P., Gottschalk M., Koch M. L., Trainor K., Horwitz R. I. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med. 1994 Sep 29;331(13):821–827. doi: 10.1056/NEJM199409293311301. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES