Oral drug therapy prevented recurrent syncope or presyncope in 94% of patients with neurocardiogenic syncope and bradycardia/asystole at 16 months, whereas artificial pacing was ineffective.
Observational (n=22)
Does artificial cardiac pacing prevent hypotension and syncope during head-up tilt testing compared to oral drug therapy in patients with neurocardiogenic syncope associated with bradycardia or asystole?
In patients with neurocardiogenic syncope associated with bradycardia or asystole, oral drug therapy is highly effective in preventing syncope, whereas artificial pacing is not.
BACKGROUND: The efficacy of permanent cardiac pacing in patients with neurocardiogenic (or vasovagal) syncope associated with bradycardia or asystole is not clear. We compared the efficacy of cardiac pacing with that of oral drug therapy in the prevention of hypotension and syncope during head-up tilt testing. METHODS: Among 70 patients with a history of syncope in whom hypotension and syncope could be provoked during head-up tilt testing, 22 had bradycardia (a heart rate < 60 beats per minute, with a decline in the rate by at least 20 beats per minute) or asystole along with hypotension during testing. There were 9 men and 13 women, with a mean (+/- SD) age of 41 +/- 17 years. Head-up tilt testing was repeated during atrioventricular sequential pacing (in 20 patients with sinus rhythm) or ventricular pacing (in 2 patients with atrial fibrillation). Regardless of the results obtained during artificial pacing, all the patients subsequently had upright-tilt testing repeated during therapy with oral metoprolol, theophylline, or disopyramide. RESULTS: During the initial tilt test, 6 patients had asystole and 16 had bradycardia along with hypotension. Despite artificial pacing, the mean arterial pressure during head-up tilt testing still fell significantly, from 97 +/- 19 to 57 +/- 19 mm Hg (P < 0.001); 5 patients had syncope, and 15 had presyncope. By contrast, 19 patients who later received only medical therapy (metoprolol in 10, theophylline in 3, and disopyramide in 6), 2 patients who received both metoprolol and atrioventricular sequential pacing, and 1 patient who received only atrioventricular sequential pacing had negative head-up tilt tests. After a median follow-up of 16 months, 18 of the 19 patients who were treated with drugs alone (94 percent) remained free of recurrent syncope or presyncope, whereas the patient treated only with permanent dual-chamber pacemaker had recurrent syncope. CONCLUSIONS: In patients with neurocardiogenic syncope associated with bradycardia or asystole, drug therapy is often effective in preventing syncope, whereas artificial pacing is not.
Jasbir et al. (Thu,) conducted a observational in Neurocardiogenic (vasovagal) syncope with bradycardia or asystole (n=22). Cardiac pacing vs. Oral drug therapy (metoprolol, theophylline, or disopyramide) was evaluated on Prevention of hypotension and syncope during head-up tilt testing. Oral drug therapy prevented recurrent syncope or presyncope in 94% of patients with neurocardiogenic syncope and bradycardia/asystole at 16 months, whereas artificial pacing was ineffective.