Why the study?
Recurrent vasovagal syncope can be debilitating and non-pharmacological management has variable success, while mechanistic understanding and appropriate patient selection for pacing remain unclear.
Does permanent pacing prevent syncope recurrence in patients with recurrent cardioinhibitory vasovagal syncope?
Does permanent pacing prevent syncope recurrence in patients with recurrent cardioinhibitory vasovagal syncope?
Permanent pacing, particularly using dual-chamber devices with closed-loop stimulation, is an effective secondary prevention strategy for older patients with severe, recurrent cardioinhibitory vasovagal syncope refractory to conservative management.
Timing of bradycardia may guide pacing in recurrent cardioinhibitory VVS; leaves open optimal selection for prospective trials.
Vasovagal Syncope (VVS) is mediated by a cardiac autonomic reflex with resultant bradycardia and hypotension, precipitating syncope. While benign and mostly well controlled, recurrent VVS can be debilitating and warrants intervention. Non-pharmacological management of VVS have had variable success. In patients with recurrent cardioinhibitory VVS, permanent pacing can be effective. The utility of pacing to preempt the syncopal depends on the prominent temporal role of bradycardia during the vasovagal reflex. Current guidelines recommend pacing as a therapy to consider in older patients with recurrent VVS. Although younger patients can benefit, one should be cautious given the long-term risk of complications. Available data appears to favor a dual chamber pacemaker with closed loop stimulation algorithm to prevent recurrent cardioinhibitory VVS. Several aspects, including mechanistic understanding of VVS and appropriate patient selection, remain unclear, and require further study.
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A 2020 study studied this question.
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