@article {45930,
	title = {Permanent pacemaker implantation in octogenarians with unexplained syncope and positive electrophysiologic testing.},
	journal = {Heart Rhythm},
	volume = {14},
	year = {2017},
	month = {2017 May},
	pages = {694-699},
	abstract = {BACKGROUND: Syncope is a common problem in the elderly, and a permanent pacemaker is a therapeutic option when a bradycardic etiology is revealed. However, the benefit of pacing when no association of symptoms to bradycardia has been shown is not clear, especially in the elderly.

OBJECTIVE: The aim of this study was to evaluate the effect of pacing on syncope-free mortality in patients aged 80 years or older with unexplained syncope and "positive" invasive electrophysiologic testing (EPT).

METHODS: This was an observational study. A positive EPT for the purposes of this study was defined by at least 1 of the following: a corrected sinus node recovery time of >525 ms, a basic HV interval of >55 ms, detection of infra-Hisian block, or appearance of second-degree atrioventricular block on atrial decremental pacing at a paced cycle length of >400 ms.

RESULTS: Among the 2435 screened patients, 228 eligible patients were identified, 145 of whom were implanted with a pacemaker. Kaplan-Meier analysis determined that time to event (syncope or death) was 50.1 months (95\% confidence interval 45.4-54.8 months) with a pacemaker vs 37.8 months (95\% confidence interval 31.3-44.4 months) without a pacemaker (log-rank test, P = .001). The 4-year time-dependent estimate of the rate of syncope was 12\% vs 44\% (P < .001) and that of any-cause death was 41\% vs 56\% (P = .023), respectively. The multivariable odds ratio was 0.25 (95\% confidence interval 0.15-0.40) after adjustment for potential confounders.

CONCLUSION: In patients with unexplained syncope and signs of sinus node dysfunction or impaired atrioventricular conduction on invasive EPT, pacemaker implantation was independently associated with longer syncope-free survival. Significant differences were also shown in the individual components of the primary outcome measure (syncope and death from any cause).},
	keywords = {Aged, 80 and over, Bradycardia, Cardiac Pacing, Artificial, Electrophysiologic Techniques, Cardiac, Heart Block, Humans, Pacemaker, Artificial, Syncope},
	issn = {1556-3871},
	doi = {10.1016/j.hrthm.2017.01.012},
	author = {Giannopoulos, Georgios and Kossyvakis, Charalampos and Panagopoulou, Vasiliki and Tsiachris, Dimitrios and Doudoumis, Konstantinos and Mavri, Maria and Vrachatis, Dimitrios and Letsas, Konstantinos and Efremidis, Michael and Katsivas, Apostolos and Lekakis, John and Deftereos, Spyridon}
}
