Efficacy of permanent pacing in the management of high-risk patients with long QT syndrome

A. J. Moss, J. E. Liu, S. Gottlieb, E. H. Locati, P. J. Schwartz, J. L. Robinson

Research output: Contribution to journalArticlepeer-review

Abstract

Background. From the international long QT syndrome (LQTS) study, 30 patients with corrected QT interval (QT(c)) 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 QT(c) 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<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.

Original languageEnglish
Pages (from-to)1524-1529
Number of pages6
JournalCirculation
Volume84
Issue number4
DOIs
StatePublished - 1991
Externally publishedYes

Keywords

  • Long QT syndrome
  • Pacemaker
  • Sudden cardiac death
  • Syncope

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