ASPIRED
To start, Professor Matthew Reed (The Usher Institute - Edinburgh, UK) described the ASPIRED trial in adults presenting to the ED with unexplained syncope, which investigated 14-day cardiac monitoring at the index visit compared with standard care. The researchers found no significant difference in the mean number of self-reported syncope episodes at 1 year between ECG monitoring and standard care (1.37 vs. 1.58; p=0.43). However, monitoring more than doubled the detection of clinically significant cardiac arrhythmias (22% vs. 9%) and led to earlier diagnosis (median 22 vs. 55 days). In addition, monitoring increased the proportion of patients who received pacemaker implantation (6.8% vs. 4.6%) and anti-arrhythmic therapy (10.8% vs. 7.3%). Of note, monitoring was associated with a 50% reduction in all-cause mortality (1.5% vs. 2.9%) at 1 year. “These findings suggest that early monitoring should be considered as part of routine ED care for patients with unexplained syncope, while further research explores the observed survival benefit,” noted Prof. Reed.
DANISH-CRT
DANISH-CRT tested whether targeting the LV lead at the site of latest electrical activation in the coronary sinus branches improves outcomes in patients with an indication for CRT. As presented by Professor Jens Cosedis Nielsen (Aarhus University Hospital - Aarhus, Denmark), the primary endpoint of death or first unplanned hospitalisation for heart failure occurred in similar proportions of patients with targeted lead placement and standard lead placement (27.9% vs. 25.5%; hazard ratio 1.10; 95% CI 0.86 to 1.39; p=0.45) over a median follow-up of 45.8 months. “Our findings do not support routine electrical mapping to target LV lead placement in contemporary CRT practice,” Prof. Cosedis Nielsen concluded.
SyncAV PMT
Next, Doctor Niraj Varma (Cleveland Clinic - Cleveland, USA) discussed SyncAV PMT, which assessed dynamic triple fusion pacing with SyncAV vs. conventional fixed AV interval. CRT efficacy was robust and similar in both arms overall, but the researchers found that SyncAV reduced all-cause mortality, HF hospitalisations, persistent AF and negative echocardiographic CRT response vs. fixed AV interval in patients with PR intervals ≥185 ms.
Syncope-Stopper
The Syncope-Stopper trial, presented by Doctor Jeremy William (The Alfred Hospital - Melbourne, Australia), assessed whether upfront pacing improves outcomes in high-risk patients without documented bradycardia. The trial included patients aged 55 years or older with at least 1 unexplained syncopal episode within the previous year and a DROP score of 2 or more [1]. The primary endpoint of recurrent syncope, bradycardia requiring pacemaker, CV death and device-related complications at 1 year was significantly reduced with upfront pacing vs. standard care (17.2% vs. 31.7%; p=0.014). “The DROP score enables targeted, proactive pacing to prevent recurrent syncope and associated morbidity,” concluded Dr. William.
HIS Alternative II
The session ended with results from HIS Alternative II, presented by Doctor Michael Vinther (Rigshospitalet - Copenhagen University Hospital - Copenhagen, Denmark), which compared conduction system pacing with biventricular pacing in heart failure patients with left bundle branch block eligible for CRT. The primary endpoint of LVESV change from baseline at 6 months was noninferior between the groups, with similar LVEF, QRS width, symptoms and function capacity improvements.