{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:45:48Z","timestamp":1792809948963,"version":"4.5.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background\u2014<\/jats:title>\n                    <jats:p>In the Third International Study on Syncope of Uncertain Etiology (ISSUE-3), cardiac pacing was effective in reducing recurrence of syncope in patients with presumed neurally mediated syncope (NMS) and documented asystole but syncope still recurred in 25% of them at 2 years. We have investigated the role of tilt testing (TT) in predicting recurrences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results\u2014<\/jats:title>\n                    <jats:p>\n                      In 136 patients enrolled in the ISSUE-3, TT was positive in 76 and negative in 60. An asystolic response predicted a similar asystolic form during implantable loop recorder monitoring, with a positive predictive value of 86%. The corresponding values were 48% in patients with non\u2013asystolic TT and 58% in patients with negative TT (\n                      <jats:italic>P<\/jats:italic>\n                      =0.001 versus asystolic TT). Fifty-two patients (26 TT+ and 26 TT\u2013) with asystolic neurally mediated syncope received a pacemaker. Syncope recurred in 8 TT+ and in 1 TT\u2013 patients. At 21 months, the estimated product-limit syncope recurrence rates were 55% and 5%, respectively (\n                      <jats:italic>P<\/jats:italic>\n                      =0.004). The TT+ recurrence rate was similar to that seen in 45 untreated patients (control group), which was 64% (\n                      <jats:italic>P<\/jats:italic>\n                      =0.75). The recurrence rate was similar between 14 patients with asystolic and 12 with non\u2013asystolic responses during TT (\n                      <jats:italic>P<\/jats:italic>\n                      =0.53).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>Cardiac pacing was effective in neurally mediated syncope patients with documented asystolic episodes in whom TT was negative; conversely, there was insufficient evidence of efficacy from this data set in patients with a positive TT even when spontaneous asystole was documented. Present observations are unexpected and need to be confirmed by other studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      . Unique identifier: NCT01463358.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circep.113.001103","type":"journal-article","created":{"date-parts":[[2013,12,12]],"date-time":"2013-12-12T23:15:47Z","timestamp":1386890147000},"page":"10-16","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":108,"title":["Benefit of Pacemaker Therapy in Patients With Presumed Neurally Mediated Syncope and Documented Asystole Is Greater When Tilt Test Is Negative"],"prefix":"10.1161","volume":"7","author":[{"given":"Michele","family":"Brignole","sequence":"first","affiliation":[{"name":"From the Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy (M.B., P.D.); Department of Cardiology, Ospedale di Bolzano, Bolzano, Italy (M.T.); Department of Cardiology, Ospedale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy (R.M.); Department of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (M.I.); Hospital Xeral de Vigo, Vigo, Spain (X.B.); Hospital Universitario Vall d\u2019Hebron, Barcelona, Spain (A.M.); Hopital du Sacre-Coeur de Montreal, Montreal, Canada (T.K..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Donateo","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy (M.B., P.D.); Department of Cardiology, Ospedale di Bolzano, Bolzano, Italy (M.T.); Department of Cardiology, Ospedale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy (R.M.); Department of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (M.I.); Hospital Xeral de Vigo, Vigo, Spain (X.B.); Hospital Universitario Vall d\u2019Hebron, Barcelona, Spain (A.M.); Hopital du Sacre-Coeur de Montreal, Montreal, Canada (T.K..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Tomaino","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy (M.B., P.D.); Department of Cardiology, Ospedale di Bolzano, Bolzano, Italy (M.T.); Department of Cardiology, Ospedale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy (R.M.); Department of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (M.I.); Hospital Xeral de Vigo, Vigo, Spain (X.B.); Hospital Universitario Vall d\u2019Hebron, Barcelona, Spain (A.M.); Hopital du Sacre-Coeur de Montreal, Montreal, Canada (T.K..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Massa","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy (M.B., P.D.); Department of Cardiology, Ospedale di Bolzano, Bolzano, Italy (M.T.); Department of Cardiology, Ospedale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy (R.M.); Department of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (M.I.); Hospital Xeral de Vigo, Vigo, Spain (X.B.); Hospital Universitario Vall d\u2019Hebron, Barcelona, Spain (A.M.); Hopital du Sacre-Coeur de Montreal, Montreal, Canada (T.K..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Iori","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy (M.B., P.D.); Department of Cardiology, Ospedale di Bolzano, Bolzano, Italy (M.T.); Department of Cardiology, Ospedale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy (R.M.); Department of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (M.I.); Hospital Xeral de Vigo, Vigo, Spain (X.B.); Hospital Universitario Vall d\u2019Hebron, Barcelona, Spain (A.M.); Hopital du Sacre-Coeur de Montreal, Montreal, Canada (T.K..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xulio","family":"Beiras","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy (M.B., P.D.); Department of Cardiology, Ospedale di Bolzano, Bolzano, Italy (M.T.); Department of Cardiology, Ospedale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy (R.M.); Department of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (M.I.); Hospital Xeral de Vigo, Vigo, Spain (X.B.); Hospital Universitario Vall d\u2019Hebron, Barcelona, Spain (A.M.); Hopital du Sacre-Coeur de Montreal, Montreal, Canada (T.K..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angel","family":"Moya","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy (M.B., P.D.); Department of Cardiology, Ospedale di Bolzano, Bolzano, Italy (M.T.); Department of Cardiology, Ospedale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy (R.M.); Department of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (M.I.); Hospital Xeral de Vigo, Vigo, Spain (X.B.); Hospital Universitario Vall d\u2019Hebron, Barcelona, Spain (A.M.); Hopital du Sacre-Coeur de Montreal, Montreal, Canada (T.K..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Kus","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy (M.B., P.D.); Department of Cardiology, Ospedale di Bolzano, Bolzano, Italy (M.T.); Department of Cardiology, Ospedale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy (R.M.); Department of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (M.I.); Hospital Xeral de Vigo, Vigo, Spain (X.B.); Hospital Universitario Vall d\u2019Hebron, Barcelona, Spain (A.M.); Hopital du Sacre-Coeur de Montreal, Montreal, Canada (T.K..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Claude","family":"Deharo","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy (M.B., P.D.); Department of Cardiology, Ospedale di Bolzano, Bolzano, Italy (M.T.); Department of Cardiology, Ospedale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy (R.M.); Department of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (M.I.); Hospital Xeral de Vigo, Vigo, Spain (X.B.); Hospital Universitario Vall d\u2019Hebron, Barcelona, Spain (A.M.); Hopital du Sacre-Coeur de Montreal, Montreal, Canada (T.K..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Giuli","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy (M.B., P.D.); Department of Cardiology, Ospedale di Bolzano, Bolzano, Italy (M.T.); Department of Cardiology, Ospedale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy (R.M.); Department of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (M.I.); Hospital Xeral de Vigo, Vigo, Spain (X.B.); Hospital Universitario Vall d\u2019Hebron, Barcelona, Spain (A.M.); Hopital du Sacre-Coeur de Montreal, Montreal, Canada (T.K..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Gentili","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy (M.B., P.D.); Department of Cardiology, Ospedale di Bolzano, Bolzano, Italy (M.T.); Department of Cardiology, Ospedale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy (R.M.); Department of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy (M.I.); Hospital Xeral de Vigo, Vigo, Spain (X.B.); Hospital Universitario Vall d\u2019Hebron, Barcelona, Spain (A.M.); Hopital du Sacre-Coeur de Montreal, Montreal, Canada (T.K..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Sutton","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy (M.B., P.D.); Department of Cardiology, Ospedale di Bolzano, Bolzano, Italy (M.T.); Department of Cardiology, Ospedale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy (R.M.); Department of Cardiology, Arcispedale S. 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September 20 2013. doi:10.1093\/europace\/eut283. http:\/\/europace.oxfordjournals.org\/.","DOI":"10.1093\/europace\/eut283"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(91)90491-3"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(93)90427-3"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.12.045"}],"container-title":["Circulation: Arrhythmia and Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCEP.113.001103","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T20:11:07Z","timestamp":1715544667000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCEP.113.001103"}},"subtitle":["An Analysis From the Third International Study on Syncope of Uncertain Etiology (ISSUE-3)"],"short-title":[],"issued":{"date-parts":[[2014,2]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2014,2]]}},"alternative-id":["10.1161\/CIRCEP.113.001103"],"URL":"https:\/\/doi.org\/10.1161\/circep.113.001103","relation":{},"ISSN":["1941-3149","1941-3084"],"issn-type":[{"value":"1941-3149","type":"print"},{"value":"1941-3084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,2]]},"assertion":[{"value":"2013-06-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-11-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-12-12","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}