{"id":67882,"date":"2026-09-03T05:34:22","date_gmt":"2026-09-03T00:04:22","guid":{"rendered":"https:\/\/johnsonfrancis.org\/professional\/?p=67882"},"modified":"2026-09-03T05:34:24","modified_gmt":"2026-09-03T00:04:24","slug":"the-syncope-stopper-study-drop-score","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/the-syncope-stopper-study-drop-score\/","title":{"rendered":"The Syncope-Stopper Study &amp; DROP score"},"content":{"rendered":"<iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/jTks-eLzpR0?si=3haKrbWMfsOtFHzt\" title=\"YouTube video player\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n\n<p class=\"wp-block-paragraph\">The <strong>Syncope-Stopper Study<\/strong> (<a href=\"https:\/\/www.anzctr.org.au\/Trial\/Registration\/TrialReview.aspx?ACTRN=ACTRN12622001553763\" data-type=\"link\" data-id=\"https:\/\/www.anzctr.org.au\/Trial\/Registration\/TrialReview.aspx?ACTRN=ACTRN12622001553763\">ANZCTR Registration: ACTRN12622001553763<\/a>) is an Australian randomized controlled trial evaluating the safety, efficacy, and cost-effectiveness of early pacemaker implantation compared to standard care for high-risk patients presenting with unexplained syncope. <\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Study Design &amp; Objective<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The central hypothesis is that an upfront permanent pacemaker (the &#8220;Syncope-Stopper&#8221;) is the safest and most optimal management strategy for a specific subset of high-risk patients, eliminating the need for prolonged diagnostic monitoring.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"\"><strong>Design:<\/strong> Open-label, parallel-group, randomized controlled trial.<\/li>\n\n\n\n<li class=\"\"><strong>Target Enrollment:<\/strong> Approximately 180 participants (90 per group). Final results show <a href=\"https:\/\/x.com\/DrMarthaGulati\/status\/2094348213721485660\" data-type=\"link\" data-id=\"https:\/\/x.com\/DrMarthaGulati\/status\/2094348213721485660\">200 participants<\/a><\/li>\n\n\n\n<li class=\"\"><strong>Lead Institution:<\/strong> Monash University.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Participant Population<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"\">Adults hospitalized with unexplained syncope.<\/li>\n\n\n\n<li class=\"\">Patients must exhibit additional high-risk features for recurrent syncope. The study utilizes a novel <strong>DROP score<\/strong> to help identify the patients at the highest risk of bradycardia.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Treatment Arms<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Participants were randomized 1:1 into two groups:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"\"><strong>Intervention (Upfront Pacing):<\/strong> Patients undergo immediate implantation of a permanent pacemaker by a cardiac electrophysiologist or cardiologist.<\/li>\n\n\n\n<li class=\"\"><strong>Control (Standard Care):<\/strong> Patients receive conventional management as dictated by their treating medical team. At the clinician&#8217;s discretion, this may include no further investigations, Holter monitoring, or the insertion of an implantable loop recorder (ILR).<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">According to a <a href=\"https:\/\/x.com\/DrMarthaGulati\/status\/2094348213721485660\/photo\/1\" data-type=\"link\" data-id=\"https:\/\/x.com\/DrMarthaGulati\/status\/2094348213721485660\/photo\/1\">summary posted on X<\/a>, device type, manufacturer and programming was left to the discretion of the implanter. Loop recorder was designated as the primary monitoring modality.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Primary Endpoints<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Participants are followed through face-to-face visits for 12 months. The study measures a composite primary endpoint assessing the frequency of:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"\">Cardiovascular death<\/li>\n\n\n\n<li class=\"\">Recurrent syncope<\/li>\n\n\n\n<li class=\"\">Bradycardia resulting in delayed pacemaker implantation<\/li>\n\n\n\n<li class=\"\">Device-related complications<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">ESC 2026 Presentation Details<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The final results of the <strong>Syncope-Stopper trial<\/strong> were recently presented as a late-breaking clinical trial at the European Society of Cardiology (ESC) Congress in Munich.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"\"><strong>Session:<\/strong> Hot Line 10: Progress in syncope and CRT<\/li>\n\n\n\n<li class=\"\"><strong>Date:<\/strong> Monday, August 31, 2026<\/li>\n\n\n\n<li class=\"\"><strong>Presenter:<\/strong> Jeremy William (The Alfred Hospital, Melbourne, Australia)<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Key Clinical Results<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The trial evaluated whether upfront permanent pacing improves outcomes for high-risk patients (aged 55+ with at least one unexplained syncopal episode in the prior year and a DROP score \u22652) without documented bradycardia.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"\"><strong>Primary Endpoint:<\/strong> A composite of recurrent syncope, bradycardia requiring a pacemaker, cardiovascular death, and device-related complications at 12 months.<\/li>\n\n\n\n<li class=\"\"><strong>Findings:<\/strong> Upfront pacing significantly reduced the primary endpoint compared to standard care <strong>(<a href=\"https:\/\/www.escardio.org\/news\/news-room\/congress-news\/hot-line-10-progress-in-syncope-and-crt\/\" data-type=\"link\" data-id=\"https:\/\/www.escardio.org\/news\/news-room\/congress-news\/hot-line-10-progress-in-syncope-and-crt\/\">17.2% vs. 31.7%; p=0.014<\/a>)<\/strong>.<\/li>\n\n\n\n<li class=\"\"><strong>Conclusion:<\/strong> The findings suggest that utilizing the novel DROP score enables targeted, proactive pacing that successfully prevents recurrent syncope and associated morbidity in this high-risk population.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Reference<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Because the trial was just presented as a late-breaking Hot Line study at ESC 2026, the primary outcomes data is currently available via the ESC Congress presentations and press materials.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Reference<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>DROP score<\/strong> is a 4-point clinical risk tool used to predict which patients with unexplained syncope are at the highest risk for bradyarrhythmias and would most likely benefit from a permanent pacemaker. It was derived by analyzing patients who received implantable loop recorders (ILRs) to identify which baseline clinical and ECG characteristics strongly predicted the eventual need for pacing.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Score Components<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The acronym represents four independent predictors, with 1 point assigned for each present factor (maximum score of 4):<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><td><strong>Letter<\/strong><\/td><td><strong>Clinical Predictor<\/strong><\/td><td><strong>Definition<\/strong><\/td><\/tr><\/thead><tbody><tr><td><strong>D<\/strong><\/td><td><strong>D<\/strong>istal conduction disease<\/td><td>Presence of bundle branch block or fascicular block on baseline ECG<\/td><\/tr><tr><td><strong>R<\/strong><\/td><td>p<strong>R<\/strong> interval prolongation<\/td><td>First-degree AV block on baseline ECG<\/td><\/tr><tr><td><strong>O<\/strong><\/td><td><strong>O<\/strong>lder age<\/td><td>Age &gt; 65 years<\/td><\/tr><tr><td><strong>P<\/strong><\/td><td><strong>P<\/strong>recipitating factors absent<\/td><td>Lack of typical vasovagal triggers (e.g., overheating, posture changes, or exercise)<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Interpretation<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"\"><strong>Score 0\u20131:<\/strong> Low risk. In the derivation study, no patients with a score of 0 progressed to needing a pacemaker over 3 years of follow-up.<\/li>\n\n\n\n<li class=\"\"><strong>Score \u22652:<\/strong> High risk. A score of 2 or greater strongly predicts the requirement for pacing. This \u22652 threshold is what the recent Syncope-Stopper trial uses as a core inclusion criterion for its upfront pacing intervention arm.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Reference<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">While the Syncope-Stopper trial protocol was presented at ESC 2026, the DROP score itself was originally developed and published by the same Australian research group in 2022.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Xiao, X., William, J., Kistler, P. M., &amp; Voskoboinik, A. (2022). <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/35370087\/\" data-type=\"link\" data-id=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/35370087\/\">Prediction of Pacemaker Requirement in Patients With Unexplained Syncope: The DROP Score<\/a>. <em>Heart, Lung and Circulation<\/em>, 31(7), 999-1005.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Syncope-Stopper Study (ANZCTR Registration: ACTRN12622001553763) is an Australian randomized controlled trial evaluating the safety, efficacy, and cost-effectiveness of early pacemaker implantation compared to standard care for high-risk patients presenting with unexplained syncope. Study Design &amp; Objective The central hypothesis is that an upfront permanent pacemaker (the &#8220;Syncope-Stopper&#8221;) is the safest and most optimal management [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":67889,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[9],"tags":[],"class_list":["post-67882","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>The Syncope-Stopper Study &amp; DROP score - All About Cardiovascular System and Disorders<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/the-syncope-stopper-study-drop-score\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The Syncope-Stopper Study &amp; DROP score - All About Cardiovascular System and Disorders\" \/>\n<meta property=\"og:description\" content=\"The Syncope-Stopper Study (ANZCTR Registration: ACTRN12622001553763) is an Australian randomized controlled trial evaluating the safety, efficacy, and cost-effectiveness of early pacemaker implantation compared to standard care for high-risk patients presenting with unexplained syncope. 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