Key result
Permanent pacemaker therapy for neurocardiogenic syncope remains controversial, as the onset of hypotension usually precedes bradycardia, suggesting pacing may not prevent syncope or presyncope.
Why the study?
Does permanent pacemaker therapy prevent syncope or presyncope in patients with neurocardiogenic (vasovagal) syncope?
Does permanent pacemaker therapy prevent syncope or presyncope in patients with neurocardiogenic (vasovagal) syncope?
Cardiac pacing for neurocardiogenic syncope remains controversial because vasodepression (hypotension) typically precedes cardioinhibition (bradycardia), limiting the efficacy of pacing alone.
Answers are grounded in this paper and cite their sources.
Caution against routine pacing in neurocardiogenic syncope; leaves open need for trials targeting vasodepressor mechanisms.
Head-up tilt testing is increasingly being used as a diagnostic modality in patients with unexplained syncope who are thought to have neurocardiogenic (vasovagal) mechanisms of syncope. Although large-scale placebo-controlled trials are still awaited, pharmacologic therapy is usually effective in preventing syncope or presyncope in this patient population. However, the role of permanent pacemaker therapy remains controversial. Because hypotension is usually associated with paradoxical bradycardia and occasionally asystole, it has been argued that permanent pacemaker therapy may be useful in preventing syncope and, thus, injury, in the so-called "malignant vasovagal cardioinhibitory response" in which the onset of syncope is thought to be abrupt. The onset of hypotension, however, usually precedes bradycardia during neurocardiogenic syncope, and pacing may thus not prevent syncope or presyncope in these patients. The role of cardiac pacing in patients with neurocardiogenic syncope is reviewed.
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Jasbir et al. (1995) conducted a review in Neurocardiogenic (vasovagal) syncope. Permanent pacemaker therapy was evaluated. Permanent pacemaker therapy for neurocardiogenic syncope remains controversial, as the onset of hypotension usually precedes bradycardia, suggesting pacing may not prevent syncope or presyncope.
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