{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:43:31Z","timestamp":1790912611567,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,8,3]],"date-time":"2018-08-03T00:00:00Z","timestamp":1533254400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Arrhythmia"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Vasovagal syncope (<jats:styled-content style=\"fixed-case\">VVS<\/jats:styled-content>) is defined by transient loss of consciousness with spontaneous rapid recovery. Recently, a closed\u2010loop stimulation pacing system (<jats:styled-content style=\"fixed-case\">CLS<\/jats:styled-content>) has shown superior effectiveness to conventional pacing in refractory <jats:styled-content style=\"fixed-case\">VVS<\/jats:styled-content>. However, systematic review and meta\u2010analysis has not been performed. We assessed the impact of <jats:styled-content style=\"fixed-case\">CLS<\/jats:styled-content> implantation and reduction in recurrent <jats:styled-content style=\"fixed-case\">VVS<\/jats:styled-content> events by a systematic review and a meta\u2010analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We comprehensively searched the databases of <jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">EMBASE<\/jats:styled-content> from inception to September 2017. Included studies were published prospective or retrospective cohort, randomized controlled trial, and case\u2013control studies that compared <jats:styled-content style=\"fixed-case\">VVS<\/jats:styled-content> events between recurrent, severe, or refractory cardioinhibitory <jats:styled-content style=\"fixed-case\">VVS<\/jats:styled-content> patient implanted with <jats:styled-content style=\"fixed-case\">CLS<\/jats:styled-content> and conventional pacing. Data from each study were combined using the random\u2010effects, generic inverse variance method of DerSimonian and Laird to calculate odds ratios and 95% confidence intervals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six studies from November 2004 to October 2017 were included in this meta\u2010analysis involving 224 recurrent, severe, or refractory cardioinhibitory <jats:styled-content style=\"fixed-case\">VVS<\/jats:styled-content> patients implanted with <jats:styled-content style=\"fixed-case\">CLS<\/jats:styled-content> and 163 recurrent, severe, or refractory <jats:styled-content style=\"fixed-case\">VVS<\/jats:styled-content> patients implanted with conventional pacing. <jats:styled-content style=\"fixed-case\">CLS<\/jats:styled-content> significantly reduced recurrent <jats:styled-content style=\"fixed-case\">VVS<\/jats:styled-content> events compared to conventional pacing (pooled odds ratio\u00a0=\u00a00.23, 95% confidence interval: 0.13\u20100.39, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.000, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a036.5%) as well as subgroup of four randomized controlled trial studies (pooled odds ratio\u00a0=\u00a00.28, 95% confidence interval: 0.17\u20100.44, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.000, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a039.2%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Closed\u2010loop stimulation significantly reduced recurrent <jats:styled-content style=\"fixed-case\">VVS<\/jats:styled-content> events up to 80% when compared to conventional pacing. Our study suggests that <jats:styled-content style=\"fixed-case\">CLS<\/jats:styled-content> is an effective tool for preventing syncope recurrences in patients with recurrent, severe, or refractory cardioinhibitory <jats:styled-content style=\"fixed-case\">VVS<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/joa3.12102","type":"journal-article","created":{"date-parts":[[2018,8,7]],"date-time":"2018-08-07T05:41:06Z","timestamp":1533620466000},"page":"556-564","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Closed\u2010looped stimulation cardiac pacing for recurrent vasovagal syncope: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9419-5854","authenticated-orcid":false,"given":"Pattara","family":"Rattanawong","sequence":"first","affiliation":[{"name":"University of Hawaii Internal Medicine Residency Program Honolulu 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