{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T21:06:26Z","timestamp":1779138386634,"version":"3.51.4"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,2,10]],"date-time":"2024-02-10T00:00:00Z","timestamp":1707523200000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"BIOTRONIK SE & Co . KG, Center for Clinical Research"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>A dual-chamber pacemaker with closed-loop stimulation (CLS) mode is effective in reducing syncopal recurrences in patients with asystolic vasovagal syncope (VVS). In this study, we explored the haemodynamic and temporal relationship of CLS during a tilt-induced vasovagal reflex.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Twenty patients underwent a tilt test under video recording 3.9 years after CLS pacemaker implantation. Three patients were excluded from the analysis because of no VVS induced by the tilt test (n = 1) and protocol violation (n = 2). In 14 of the remaining 17 patients, CLS pacing emerged during the pre-syncopal phase of circulatory instability when the mean intrinsic heart rate (HR) was 88 \u00b1 12\u2005b.p.m. and systolic blood pressure (SBP) was 108 \u00b1 19\u2005mmHg. The CLS pacing rate thereafter rapidly increased to 105 \u00b1 14\u2005b.p.m. within a median of 0.1\u2005min [inter-quartile range (IQR), 0.1\u20130.7\u2005min] when the SBP was 99 \u00b1 21\u2005mmHg. At the time of maximum vasovagal effect (syncope or pre-syncope), SBP was 63 \u00b1 17\u2005mmHg and the CLS rate was 95 \u00b1 13\u2005b.p.m. The onset of CLS pacing was 1.7\u2005min (IQR, 1.5\u20133.4) before syncope or lowest SBP. The total duration of CLS pacing was 5.0\u2005min (IQR, 3.3\u20138.3). Closed-loop stimulation pacing was not observed in three patients who had a similar SBP decrease from 142 \u00b1 22\u2005mmHg at baseline to 69 \u00b1 4\u2005mmHg at the time of maximum vasovagal effect, but there was no significant increase in HR (59 \u00b1 1\u2005b.p.m.).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The reproducibility of a vasovagal reflex was high. High-rate CLS pacing was observed early during the pre-syncopal phase in most patients and persisted, although attenuated, at the time of maximum vasovagal effect.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Registration<\/jats:title>\n                  <jats:p>ClinicalTrials.gov identifier: NCT06038708<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/europace\/euae045","type":"journal-article","created":{"date-parts":[[2024,2,10]],"date-time":"2024-02-10T17:38:50Z","timestamp":1707586730000},"source":"Crossref","is-referenced-by-count":12,"title":["Temporal relationship between haemodynamic changes and activation of closed-loop stimulation during a tilt-induced vasovagal syncope"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9227-0360","authenticated-orcid":false,"given":"Vincenzo","family":"Russo","sequence":"first","affiliation":[{"name":"Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania \u2018Luigi Vanvitelli\u2019\u2014Monaldi Hospital , 80126 Naples , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Tomaino","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ospedale Generale Regionale , Bolzano , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erika","family":"Parente","sequence":"additional","affiliation":[{"name":"Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania \u2018Luigi Vanvitelli\u2019\u2014Monaldi Hospital , 80126 Naples , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2619-8368","authenticated-orcid":false,"given":"Angelo","family":"Comune","sequence":"additional","affiliation":[{"name":"Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania \u2018Luigi Vanvitelli\u2019\u2014Monaldi Hospital , 80126 Naples , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1584-7944","authenticated-orcid":false,"given":"Daniele","family":"Giacopelli","sequence":"additional","affiliation":[{"name":"Research Clinical Unit, Biotronik Italy , Milan , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Napoli","sequence":"additional","affiliation":[{"name":"Research Clinical Unit, Biotronik Italy , Milan , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7327-303X","authenticated-orcid":false,"given":"Alessio","family":"Gargaro","sequence":"additional","affiliation":[{"name":"Research Clinical Unit, Biotronik Italy , Milan , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1845-5607","authenticated-orcid":false,"given":"Michele","family":"Brignole","sequence":"additional","affiliation":[{"name":"IRCCS Istituto Auxologico Italiano, Faint and Fall Research Centre, Department of Cardiology, S. 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