By S. Serge Barold, Jacques Mugica

This fresh textual content, is a vital sensible advisor for junior medical professionals and clinical scholars making the transition from scientific college to existence at the wards. .

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Extra resources for The Fifth Decade of Cardiac Pacing

Sample text

Further, there remain uncertainties regarding the potential placebo effect associated with implantation of a medical device [5,30]. The latter concern was addressed retrospectively in the VPS1 study [18] by noting the absence of pacemaker impact on presyncopal symptoms. This same issue has also been assessed directly in VPS2 (in which all patients had devices implanted) [31]. The VPS2 study results did not show a statistically significant pacing benefit at 6 months follow-up, despite an apparent divergence in the curves suggesting a pacing benefit.

The extended PVARP is perpetuated from cycle to cycle as long as the pacemaker interprets the conducted ORS as a ventricular extrasystole. Functional atrial undersensing can often be corrected or reduced by shortening the PVARP and AV delay [19]. A relatively short PVARP can often be used to prevent functional atrial undersensing because retrograde VA block is common in patients with first-degree AV block. Automatic mode switching may have to be turned off in devices where the algorithm controls the PVARP duration as a function of the tachycardia detection rate.

Notwithstanding the fact that most vasovagal syncope patients can be managed with the treatment strategies noted above, there is nevertheless a subset of afflicted individuals in whom prevention of vasovagal symptom recurrences requires more aggressive medical intervention. For example, some patients may be extremely alarmed at the prospect of a recurrence. g. job loss, insurance issues, driving restrictions) due to their susceptibility to recurrent faints. In yet others, syncope may have occurred without warning leading to an unacceptable risk of accident and physical injury.

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