F. Ammirati

1.  Asystolic Tilt Test and PM
2.  Dual Chamber pacemaker with
RDR-algorithm vs other
possible algorithms
Europace. 2012 Jul;14(7):1038-43. doi: 10.1093/europace/eur419. Epub 2012 Jan 13.
Closed-loop cardiac pacing vs. conventional dual-chamber pacing with specialized
Sensing and pacing algorithms for syncope prevention in patients with refractory vasovagal syncope:
results of a long-term follow-up.
Palmisano P1, Zaccaria M, Luzzi G, Nacci F, Anaclerio M, Favale S
41 patients (44% male, 53 ± 16 years) with recurrent, refractory VVS (26% with trauma) and a cardioinhibitory response to HUTT
25 patients received a dual-chamber CLS pacemaker (CLS group)
16 patients received a dual-chamber pacemaker with conventional algorithms for syncope prevention (conventional pacing group):
9 patients with Medtronic rate drop response algorithm
7 patients with Guidant-Boston Scientific sudden brady response algorithm.
During the follow-up (mean 4.4 ± 3.0 years, interquartile range 2.2-7.4 years) one patient (4%) in the
CLS group and six (38%) in the conventional pacing group had syncope recurrences (P= 0.016).
retrospective analysis
BIOSync TRIAL
BENEFIT OF DUAL-CHAMBER PACING WITH CLOSED LOOP
STIMULATION (CLS) IN TILT-INDUCED (TILT-POSITIVE)
CARDIO-INHIBITORY REFLEX SYNCOPE.
A RANDOMIZED DOUBLE-BLIND PARALLEL TRIAL
Coordinating Clinical
Investigator
Dr. M. Brignole
Co-Coordinating Clinical
Ospedali del Tigullio
Investigator
Arrhythmologic Centre,
Department of Cardiology
Dr. M. Tomaino
Via Don Bobbio, 25
16033 Lavagna (GE) - Italy
Ospedale Centrale di Bolzano
Department of Cardiologia
Via Lorenz Böhler, 5
39100 Bolzano - Italy
Steering Committee:
M. Brignole, IT
A. Aerts, Heerle, NE
F. Ammirati, Roma, IT
H. Burri, Geneva, CH
J.C. Deharo, Marseille, FR
M. Hamdan, Wisconsin, US
A. Moya, Barcelona, ES
M. Tomaino, Bolzano, IT
1.  Asystolic Tilt Test and PM
2.  Dual Chamber pacemaker with
RDR-algorithm vs other
possible algorithms
BIOSync TRIAL
BENEFIT OF DUAL-CHAMBER PACING WITH CLOSED LOOP
STIMULATION (CLS) IN TILT-INDUCED (TILT-POSITIVE)
CARDIO-INHIBITORY REFLEX SYNCOPE.
A RANDOMIZED DOUBLE-BLIND PARALLEL TRIAL
Coordinating Clinical
Investigator
Dr. M. Brignole
Co-Coordinating Clinical
Ospedali del Tigullio
Investigator
Arrhythmologic Centre,
Department of Cardiology
Dr. M. Tomaino
Via Don Bobbio, 25
16033 Lavagna (GE) - Italy
Ospedale Centrale di Bolzano
Department of Cardiologia
Via Lorenz Böhler, 5
39100 Bolzano - Italy
Steering Committee:
M. Brignole, IT
A. Aerts, Heerle, NE
F. Ammirati, Roma, IT
H. Burri, Geneva, CH
J.C. Deharo, Marseille, FR
M. Hamdan, Wisconsin, US
A. Moya, Barcelona, ES
M. Tomaino, Bolzano, IT
BIOSync
TRIAL
PERCHE ‘ NON IMPIANTARE IL PACEMAKER
1.  Natura benigna della sincope riflessa neuromediata
2. Non ancora una decisa letteratura scientifica a favore del
pacemaker
3. 25% di recidive sincopali a due anni nonostante il
pacemaker
4. Terapie alternative meno aggressive, in classe I sec. linee
guida ESC