{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T21:06:23Z","timestamp":1779138383884,"version":"3.51.4"},"reference-count":32,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,7,2]],"date-time":"2023-07-02T00:00:00Z","timestamp":1688256000000},"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":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pacing for vasovagal syncope is established. Two pacing algorithms are available. The rate\u2010drop\u2010response (RDR\u2010Medtronic) is triggered by falling heart rate acting with modified rate\u2010hysteresis. The closed loop stimulation or system (CLS\u2010Biotronik) is triggered by impedance changes in the right ventricle reflecting falling volume and rising contractility. These are very different physiologically. Both algorithms carry favorable reports in clinical use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A randomized\u2010controlled superiority trial is proposed to compare the two algorithms for the control of vasovagal syncope in patients for whom pacing is indicated by current guidelines in North America and Europe. Available recent evidence may be seen as supporting superiority of CLS. No comparison between the two algorithms has been made. In this trial, patients will be centrally randomized to one or other algorithm on a 1:1 basis. Two\u2010hundred\u2010seventy\u2010six patients in each group will be recruited. Sample size is determined using a confidence interval of 95%, a power of 90%, and a drop\u2010out rate of 10% to detect an 11% difference between CLS and RDR. Recurrent symptom comparison will be made by an independent committee. The Co\u2010primary endpoints will be recurrent syncope burden compared with that in 24\u2010months preimplant, and occurrence of syncope in 24\u2010months follow\u2010up. Each outcome will be compared between the two algorithms. Secondary endpoints will be program and drug therapy changes over 24\u2010months follow\u2010up and quality of life by questionnaire at baseline,1 and 2 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and Conclusions<\/jats:title><jats:p>These are anticipated to clarify the device algorithm choice and, therefore, to improve patient care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.15991","type":"journal-article","created":{"date-parts":[[2023,7,2]],"date-time":"2023-07-02T12:19:00Z","timestamp":1688300340000},"page":"1744-1749","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Prospective randomized study comparing permanent pacing with rate drop response and closed loop stimulation in patients with vasovagal syncope where permanent pacing is indicated and selected as the appropriate treatment option"],"prefix":"10.1111","volume":"34","author":[{"given":"Atul","family":"Prakash","sequence":"first","affiliation":[{"name":"Rutgers Medical School Newark New Jersey USA"},{"name":"Prime Health Care Newark New Jersey USA"},{"name":"St Mary's General Hospital Passaic New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5710-1094","authenticated-orcid":false,"given":"Richard","family":"Sutton","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hammersmith Hospital Campus of National Heart &amp; Lung Institute Imperial College London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,7,2]]},"reference":[{"key":"e_1_2_19_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab364"},{"key":"e_1_2_19_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(98)00549-X"},{"key":"e_1_2_19_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.102.3.294"},{"key":"e_1_2_19_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.082313"},{"key":"e_1_2_19_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.08.026"},{"key":"e_1_2_19_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa936"},{"key":"e_1_2_19_8_1","unstructured":"SuttonR BourgeoisICardiac pacemaker with hysteresis behavior. 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