Key result
Prophylactic temporary pacing successfully manages severe bradycardia during cesarean section in neurally mediated syncope.
Why the study?
Does temporary pacemaker insertion prevent severe bradycardia during cesarean section in a pregnant patient with neurally mediated syncope?
Case Report (n=1)
No
Does temporary pacemaker insertion prevent severe bradycardia during cesarean section in a pregnant patient with neurally mediated syncope?
Prophylactic temporary pacemaker insertion is an effective strategy to manage severe intraoperative bradycardia and ensure hemodynamic stability during cesarean section in pregnant patients with neurally mediated syncope.
May support prophylactic pacing consideration in select NMS cesarean cases; hypothesis-generating and requires prospective validation.
A 39-year-old pregnant woman with a history of neurally mediated syncope (NMS) and a documented eight-second sinus arrest on her Holter electrocardiography (ECG) was scheduled for cesarean delivery. A temporary pacemaker (PM) was inserted preoperatively to prevent severe bradycardia. Combined epidural and spinal anesthesia (CESA) was carried out. Intraoperatively, severe bradycardia triggered PM activation. Prompt administration of ephedrine and atropine sulfate stabilized her vital signs, and the PM was deactivated within two minutes. The cesarean section proceeded without further complications, and both mother and neonate had favorable outcomes. The PM was removed on postoperative day 2, and no syncope episodes were observed during hospitalization or follow-up. This case demonstrates the effectiveness of temporary PM use in preventing severe bradycardia during cesarean section in a patient with NMS. Multidisciplinary planning and individualized hemodynamic management are essential for achieving safe delivery outcomes in high-risk pregnancies complicated by reflex syncope.
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Takaki et al. (2025) conducted a case report in Neurally mediated syncope in pregnancy (n=1). Temporary pacemaker was evaluated on Hemodynamic stability during cesarean section. Prophylactic insertion of a temporary pacemaker successfully managed intraoperative severe bradycardia and maintained hemodynamic stability during cesarean section in a pregnant patient with neurally mediated syncope.
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