{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T03:07:33Z","timestamp":1761102453357,"version":"3.40.5"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,11,22]],"date-time":"2020-11-22T00:00:00Z","timestamp":1606003200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Arrhythmia"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Significant sinus bradycardia (SB) in the context of sinus node dysfunction (SND) has been associated with neurological symptoms. The objective was to evaluate the effect of permanent pacing on the incidence of syncope in patients with rather mild degrees of SB, unexplained syncope, and \u201cpositive\u201d invasive electrophysiologic testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was an observational study based on a prospective registry of 122 consecutive mild SB patients (61.90\u00a0\u00b1\u00a018.28\u00a0years, 61.5% male, 57.88\u00a0\u00b1\u00a07.73\u00a0bpm) presenting with recurrent unexplained pre and syncope attacks admitted to our hospital for invasive electrophysiology study (EPS). \u03a4he implantation of a permanent antibradycardia pacemaker (ABP) was offered to all patients according to the results of the EPS. Eighty patients received the ABP, while 42 denied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean of reported syncope episodes was 2.23\u00a0\u00b1\u00a01.29 (or presyncope 2.36\u00a0\u00b1\u00a01.20) in the last 12\u00a0months before they were referred for a combined EP guided diagnostic and therapeutic approach. Over a mean follow\u2010up of approximately 4\u00a0years (50.39\u00a0\u00b1\u00a032.40\u00a0months), the primary outcome event (syncope) occurred in 18 of 122 patients (14.8%), 6 of 80 (7.5%) in the ABP group as compared to 12 of 42 (28.6%) in the no pacemaker group (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.002).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among patients with mild degree of SB and a history of unexplained syncope, a set of positivity criteria for the presence of EPS defined SND after differentiating reflex syncope, identifies a subset of patients who will benefit from permanent pacing.<\/jats:p><\/jats:sec>","DOI":"10.1002\/joa3.12460","type":"journal-article","created":{"date-parts":[[2020,11,23]],"date-time":"2020-11-23T03:40:13Z","timestamp":1606102813000},"page":"189-195","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Permanent pacemaker implantation in unexplained syncope patients with borderline sinus bradycardia and electrophysiology study\u2010proven sinus node disease"],"prefix":"10.1002","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2184-3296","authenticated-orcid":false,"given":"Ioannis","family":"Doundoulakis","sequence":"first","affiliation":[{"name":"First Department of Cardiology National and Kapodistrian University \u201cHippokration\u201d Hospital Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6628-0303","authenticated-orcid":false,"given":"Konstantinos A.","family":"Gatzoulis","sequence":"additional","affiliation":[{"name":"First Department of Cardiology National and Kapodistrian University \u201cHippokration\u201d Hospital Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4426-8407","authenticated-orcid":false,"given":"Petros","family":"Arsenos","sequence":"additional","affiliation":[{"name":"First Department of Cardiology National and Kapodistrian University \u201cHippokration\u201d Hospital Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Polychronis","family":"Dilaveris","sequence":"additional","affiliation":[{"name":"First Department of Cardiology National and Kapodistrian University \u201cHippokration\u201d Hospital Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioannis","family":"Skiadas","sequence":"additional","affiliation":[{"name":"First Department of Cardiology National and Kapodistrian University \u201cHippokration\u201d Hospital Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitrios","family":"Tsiachris","sequence":"additional","affiliation":[{"name":"Athens Heart Center Athens Medical Center Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4861-2404","authenticated-orcid":false,"given":"Christos\u2010Konstantinos","family":"Antoniou","sequence":"additional","affiliation":[{"name":"First Department of Cardiology National and Kapodistrian University \u201cHippokration\u201d Hospital Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stergios","family":"Soulaidopoulos","sequence":"additional","affiliation":[{"name":"First Department of Cardiology National and Kapodistrian University \u201cHippokration\u201d Hospital Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Karystinos","sequence":"additional","affiliation":[{"name":"First Department of 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Cardiology National and Kapodistrian University \u201cHippokration\u201d Hospital Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitrios","family":"Tousoulis","sequence":"additional","affiliation":[{"name":"First Department of Cardiology National and Kapodistrian University \u201cHippokration\u201d Hospital Athens 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