Journal Article

Benefit of dual-chamber pacing with Closed Loop Stimulation in tilt-induced cardio-inhibitory reflex syncope (BIOSync trial): study protocol for a randomized controlled trial

Del Rosso, Attilio, Moya, Angel, Aerts, Arnaud, Ayala-Paredes, Félix Alejandro, Hamdan, Mohamed H., Tomaino, Marco, Deharo, Jean-Claude, Lunati, Maurizio, Brignole, Michele, Gargaro, Alessio, Ammirati, Fabrizio

2017

Overview

Background The efficacy of dual-chamber cardiac pacing in neuro-mediated reflex syncope with a cardio-inhibitory response to the Tilt-Table test (TT) has not been definitively assessed so far. The lack of reproducibility of results from previous studies may be partially explained by discrepancies in subject selection and some weaknesses in design and methods. The European Society of Cardiology (ESC) has set a class IIb indication to pacemaker implantation in this population recommending further research. Methods/design The BIOSync study is a multicenter, patient- and outcome-assessor-blind, randomized, parallel-arm, placebo-controlled trial with the objective of assessing the clinical benefit of cardiac pacing in patients with frequently recurrent reflex syncope, suspected (but not proven) to be triggered by asystolic pauses as showing a VASIS 2B response to the TT (>3-s pause regardless of blood pressure drop). The primary and secondary endpoints are time to first post-implantation recurrence of syncope or the combination of pre-syncope or syncope, respectively. One hundred and twenty-eight consenting patients will be 1:1 randomized to dual-chamber cardiac pacing ‘on’ or ‘off’ after pacemaker implantation, and followed up until the first adjudicated primary endpoint event for a maximum of 2 years. The so-called Closed Loop Stimulation function on top of dual-chamber pacing is the pacing mode selected in the study active arm. Participating patients are asked to self-report syncopal symptoms at least every 3 months with self-administered questionnaires addressed to an independent Adjudication Committee. Patients and members of the Adjudicating Committee are blinded to randomization. The study is designed to detect a 40% relative reduction in the 2-year incidence of syncopal recurrences with 80% statistical power. Discussion The BIOSync study is designed to definitively assess the benefit of pacing against placebo in reflex syncope patients with a cardio-inhibitory response to the TT. The study will also provide important information on the efficiency of the TT in appropriately selecting reflex syncope patients for cardiac pacing. Trial registration ClinicalTrials.gov, identifier: NCT02324920 (27 October 2016, date last accessed).

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Analysis / Biomedicine / Blood pressure / Cardiac arrhythmia / Cardiac pacing / Cardiac patients / Cardiology and cardiovascular system / Cardiomyopathy / Clinical trials / Consciousness / Consent / Electrocardiography / Ethics / Fainting / Health aspects / Health Sciences / Human health and pathology / Life Sciences / Medical equipment / Medicine / Medicine & Public Health / Meetings / Neuro-mediated reflex syncope / Outcome and process assessment (Health Care) / Pacemakers / Participation / Patients / Statistics for Life Sciences / Study Protocol / Tilt-Table test