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Circulation, Vol 84, 1524-1529, Copyright © 1991 by American Heart Association
AJ Moss, JE Liu, S Gottlieb, EH Locati, PJ Schwartz and JL Robinson
BACKGROUND. From the international long QT syndrome (LQTS) study, 30
patients with corrected QT interval (QTc) of more than 0.44 second 1/2 were
identified who had permanent pacemakers implanted for management of
recurrent syncope or aborted cardiac arrest. METHODS AND RESULTS.
Pacemakers were implanted on average 7 years after the onset of the first
syncopal episode. Most of the patients were female (87%), the average age
at implantation was 19 +/- 13 years, the mean QTc was 0.55 +/- 0.08 second,
and 57% were receiving antiadrenergic treatment for LQTS when the pacemaker
was placed. Using birth as the time origin, the median cardiac event rate
was significantly (p less than 0.001) reduced by pacing from 0.5 to 0
events per patient per year, with 21 patients experiencing no cardiac
events during an average pacemaker follow-up of 49 months per patient. In
10 patients in whom the demand atrial pacing rate was faster than the
intrinsic sinus rate, the average heart rate was increased 23 beats/min
(from 58 to 81 beats/min) with pacing with reduction in the QT interval
from 0.59 seconds to 0.46 seconds. CONCLUSIONS. The beneficial effects of
pacing in high-risk LQTS patients probably relate to the prevention of
bradycardia, pauses, and the shortening of long QT intervals--factors that
are known to be arrhythmogenic in this syndrome. Permanent cardiac pacing
reduces the rate of recurrent syncopal events in high-risk LQTS patients,
but it does not provide complete protection.
ARTICLES
Efficacy of permanent pacing in the management of high-risk patients with long QT syndrome
Department of Medicine, University of Rochester School of Medicine and Dentistry, NY 14642.
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