{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:20:23Z","timestamp":1785428423491,"version":"3.56.0"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2014,2,4]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>There is a relative paucity of studies investigating the mechanisms of syncope among heart failure patients with implantable cardioverter-defibrillators, and it is controversial whether nonarrhythmogenic syncope is associated with increased mortality.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              The Multicenter Automatic Defibrillator Implantation Trial\u2013Reduce Inappropriate Therapy (MADIT-RIT) randomized 1500 patients to 3 different implantable cardioverter-defibrillator programming arms: (1) Conventional programming with therapy for ventricular tachycardia \u2265170 bpm; (2) high-rate cutoff with therapy for ventricular tachycardia \u2265200 bpm and a monitoring zone at 170 to 199 bpm, and (3) prolonged 60-second delay with a monitoring zone before therapy. Syncope was a prespecified safety end point that was adjudicated independently. Multivariable Cox models were used to identify risk factors associated with syncope and to analyze subsequent risk of mortality. During follow-up, 64 of 1500 patients (4.3%) had syncope. The incidence of syncope was similar across the 3 treatment arms. Prognostic factors for all-cause syncope included the presence of ischemic cardiomyopathy (hazard ratio [HR], 2.48; 95% confidence interval [CI], 1.42\u20134.34;\n              <jats:italic>P<\/jats:italic>\n              =0.002), previous ventricular arrhythmias (HR, 2.99; 95% CI, 1.18\u20137.59;\n              <jats:italic>P<\/jats:italic>\n              =0.021), left ventricular ejection fraction \u226425% (HR, 1.65; 95% CI, 0.98\u20132.77;\n              <jats:italic>P<\/jats:italic>\n              =0.059), and younger age (by 10 years; HR, 1.25; 95% CI, 1.00\u20131.52;\n              <jats:italic>P<\/jats:italic>\n              =0.046). Syncope was associated with increased risk of death regardless of its cause (arrhythmogenic syncope: HR, 4.51; 95% CI, 1.39\u201314.64,\n              <jats:italic>P<\/jats:italic>\n              =0.012; nonarrhythmogenic syncope: HR, 2.97; 95% CI, 1.07\u20138.28,\n              <jats:italic>P<\/jats:italic>\n              =0.038).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Innovative programming of implantable cardioverter-defibrillators with therapy for ventricular tachycardia \u2265200 bpm or a long delay is not associated with increased risk of arrhythmogenic or all-cause syncope, and syncope caused by slow ventricular tachycardias (&lt;200 bpm) is a rare event. The clinical risk factors associated with syncope are related to increased cardiovascular risk profile, and syncope is associated with increased mortality irrespective of the cause.<\/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: NCT00947310.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.113.004196","type":"journal-article","created":{"date-parts":[[2013,11,8]],"date-time":"2013-11-08T02:45:02Z","timestamp":1383878702000},"page":"545-552","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":43,"title":["Syncope in High-Risk Cardiomyopathy Patients With Implantable Defibrillators: Frequency, Risk Factors, Mechanisms, and Association With Mortality"],"prefix":"10.1161","volume":"129","author":[{"given":"Martin H.","family":"Ruwald","sequence":"first","affiliation":[{"name":"From the Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.H.R., S.M., W.Z., A.J.M.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.H.R.); Department of Cardiology, Hirosaki University Hospital, Hirosaki, Japan (K.O.); Department of Cardiology, Kyoto University Hospital, Kyoto, Japan (T.K.); Department of Cardiology, Tsukuba University Hospital, Tsukuba, Japan (K.A.); and Department of Cardiology, Tokyo Women\u2019s..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Okumura","sequence":"additional","affiliation":[{"name":"From the Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.H.R., S.M., W.Z., A.J.M.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.H.R.); Department of Cardiology, Hirosaki University Hospital, Hirosaki, Japan (K.O.); Department of Cardiology, Kyoto University Hospital, Kyoto, Japan (T.K.); Department of Cardiology, Tsukuba University Hospital, Tsukuba, Japan (K.A.); and Department of Cardiology, Tokyo Women\u2019s..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Kimura","sequence":"additional","affiliation":[{"name":"From the Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.H.R., S.M., W.Z., A.J.M.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.H.R.); Department of Cardiology, Hirosaki University Hospital, Hirosaki, Japan (K.O.); Department of Cardiology, Kyoto University Hospital, Kyoto, Japan (T.K.); Department of Cardiology, Tsukuba University Hospital, Tsukuba, Japan (K.A.); and Department of Cardiology, Tokyo Women\u2019s..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazutaka","family":"Aonuma","sequence":"additional","affiliation":[{"name":"From the Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.H.R., S.M., W.Z., A.J.M.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.H.R.); Department of Cardiology, Hirosaki University Hospital, Hirosaki, Japan (K.O.); Department of Cardiology, Kyoto University Hospital, Kyoto, Japan (T.K.); Department of Cardiology, Tsukuba University Hospital, Tsukuba, Japan (K.A.); and Department of Cardiology, Tokyo Women\u2019s..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morio","family":"Shoda","sequence":"additional","affiliation":[{"name":"From the Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.H.R., S.M., W.Z., A.J.M.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.H.R.); Department of Cardiology, Hirosaki University Hospital, Hirosaki, Japan (K.O.); Department of Cardiology, Kyoto University Hospital, Kyoto, Japan (T.K.); Department of Cardiology, Tsukuba University Hospital, Tsukuba, Japan (K.A.); and Department of Cardiology, Tokyo Women\u2019s..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Kutyifa","sequence":"additional","affiliation":[{"name":"From the Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.H.R., S.M., W.Z., A.J.M.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.H.R.); Department of Cardiology, Hirosaki University Hospital, Hirosaki, Japan (K.O.); Department of Cardiology, Kyoto University Hospital, Kyoto, Japan (T.K.); Department of Cardiology, Tsukuba University Hospital, Tsukuba, Japan (K.A.); and Department of Cardiology, Tokyo Women\u2019s..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Christine H.","family":"Ruwald","sequence":"additional","affiliation":[{"name":"From the Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.H.R., S.M., W.Z., A.J.M.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.H.R.); Department of Cardiology, Hirosaki University Hospital, Hirosaki, Japan (K.O.); Department of Cardiology, Kyoto University Hospital, Kyoto, Japan (T.K.); Department of Cardiology, Tsukuba University Hospital, Tsukuba, Japan (K.A.); and Department of Cardiology, Tokyo Women\u2019s..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"McNitt","sequence":"additional","affiliation":[{"name":"From the Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.H.R., S.M., W.Z., A.J.M.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.H.R.); Department of Cardiology, Hirosaki University Hospital, Hirosaki, Japan (K.O.); Department of Cardiology, Kyoto University Hospital, Kyoto, Japan (T.K.); Department of Cardiology, Tsukuba University Hospital, Tsukuba, Japan (K.A.); and Department of Cardiology, Tokyo Women\u2019s..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Zareba","sequence":"additional","affiliation":[{"name":"From the Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.H.R., S.M., W.Z., A.J.M.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.H.R.); Department of Cardiology, Hirosaki University Hospital, Hirosaki, Japan (K.O.); Department of Cardiology, Kyoto University Hospital, Kyoto, Japan (T.K.); Department of Cardiology, Tsukuba University Hospital, Tsukuba, Japan (K.A.); and Department of Cardiology, Tokyo Women\u2019s..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur J.","family":"Moss","sequence":"additional","affiliation":[{"name":"From the Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.H.R., S.M., W.Z., A.J.M.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.H.R.); Department of Cardiology, Hirosaki University Hospital, Hirosaki, Japan (K.O.); Department of Cardiology, Kyoto University Hospital, Kyoto, Japan (T.K.); Department of Cardiology, Tsukuba University Hospital, Tsukuba, Japan (K.A.); and Department of Cardiology, Tokyo Women\u2019s..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(93)90724-F"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.11.065"},{"key":"e_1_3_4_4_2","first-page":"303","article-title":"Syncope in congestive heart failure.","volume":"15","author":"Gopinathannair R","year":"2008","unstructured":"Gopinathannair R, Mazur A, Olshansky B. Syncope in congestive heart failure. Cardiol J. 2008;15:303\u2013312.","journal-title":"Cardiol J"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.105.170274"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1211107"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-474X.2012.00531.x"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2003.11.038"},{"key":"e_1_3_4_9_2","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/j.2517-6161.1972.tb00899.x","article-title":"Regression models and life-tables.","volume":"34","author":"Cox DR","year":"1972","unstructured":"Cox DR. Regression models and life-tables. J Roy Stat Soc B. 1972;34:187\u2013220.","journal-title":"J Roy Stat Soc B"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01241-4"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eus430"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehp298"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000018125.31973.87"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(98)00644-4"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.113.004196","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T06:37:51Z","timestamp":1715582271000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.004196"}},"subtitle":["Results From the Multicenter Automatic Defibrillator Implantation Trial\u2013Reduce Inappropriate Therapy (MADIT-RIT) Study"],"short-title":[],"issued":{"date-parts":[[2014,2,4]]},"references-count":13,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2014,2,4]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.113.004196"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.113.004196","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,2,4]]},"assertion":[{"value":"2013-06-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-10-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-11-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}