Key result
Closed-loop stimulation dual-chamber pacing successfully treats severe cardioinhibitory vasovagal syncope with 20-second asystole.
Why the study?
Current pacing guidelines restrict permanent pacing for refractory cardioinhibitory vasovagal syncope to adults over 40, creating a therapeutic dilemma and grey area for younger patients when conservative treatments fail.
Case Report (n=1)
This case report illustrates the individualized use of dual-chamber closed-loop stimulation pacing in a teenage patient with severe cardioinhibitory vasovagal syncope and 20-second ventricular standstill, despite current guidelines restricting pacing to adults over 40.
Answers are grounded in this paper and cite their sources.
May inform individualized management in refractory adolescent cases despite guideline age cutoffs over 40; leaves open the long-term safety and efficacy of closed-loop pacing in youth.
Current pacing guidelines restrict permanent pacing for refractory cardioinhibitory (CI) vasovagal syncope (VVS) to adults over 40, creating a therapeutic dilemma for younger patients. We describe a patient in her late teens with recurrent, life-limiting VVS, initially presenting with episodes thought to be seizures. Subsequent monitoring confirmed a CI VVS subtype, with a severe 20 s ventricular standstill documented on telemetry. A dual-chamber pacemaker using a closed-loop stimulation algorithm was implanted to abort the profound vagal surge. This case highlights the therapeutic grey area for severe, symptomatic CI VVS in younger patients and the importance of individualised management when conservative treatments fail.
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How et al. (2026) conducted a case report in Refractory cardioinhibitory vasovagal syncope (CI VVS) with 20 s ventricular standstill (n=1). Dual-chamber pacemaker using a closed-loop stimulation algorithm was evaluated on Abortion of profound vagal surge in refractory cardioinhibitory vasovagal syncope. Dual-chamber pacing with a closed-loop stimulation algorithm was implanted in a late-teen female to treat cardioinhibitory vasovagal syncope with a 20 s ventricular standstill.
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