Why the study?
Does temporary ventricular pacing or oral midodrine prevent syncope recurrence in a pediatric patient with cardioinhibitory neurally mediated syncope and complete heart block?
Does temporary ventricular pacing or oral midodrine prevent syncope recurrence in a pediatric patient with cardioinhibitory neurally mediated syncope and complete heart block?
In a pediatric patient with cardioinhibitory neurally mediated syncope and complete heart block, temporary VVI pacing failed to prevent tilt-induced syncope due to simultaneous hypotension, whereas oral midodrine successfully prevented syncope recurrence.
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Midodrine may warrant consideration over pacing in similar pediatric cases; this single report leaves open efficacy and safety in larger cohorts.
Neurally mediated syncope (NMS) is a well-known condition that can be subdivided into three subgroups: vasopressor type, cardioinhibitory type, and mixed type. While different degrees of sinus bradycardia occur at the time of syncope in all types, complete heart block is a rare event that can lead to pulselessness during syncope. We present a case of a 14-year-old girl with documented NMS before and after temporary pacemaker implantation, who had complete heart block during syncope. The patient's temporary pacemaker placement was ineffective in preventing syncope during a repeat head-up tilt test, indicating that permanent pacing may not be effective in this patient. Midodrine, an alpha-adrenergic agonist, was started, and the patient experienced complete control of syncope episodes without recurrence during a 2-month follow-up.
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Dalili et al. (2024) studied this question.
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