Who das really benefit by the permanent cardiac pacing in cardiodepressive vasovagal syncope?

Introduction: In severe cardioinhibitory vasovagal syncope (CVS) significant bradycardia or prolonged asystole with hypotension can lead to serious injuries and psychological impairment. The aim was the clinical observation during minimum of the one year follow-up the patients with CVS under pharmacological or electrical treatment. Material and methods: We examined 34 fainting patients with tilt-induced CVS with asystole >3 s (VASIS 2B). Twenty-two patients (mean age 60.4+/-15.3 yrs) underwent implantation of a pacemaker in a dual-chamber pacing with hysteresis (pacemaker patients). Twelve patients (mean age 42.3+/-9.8 yrs) remained under pharmacological treatment (non-pacemaker patients). The number and severity of syncopalevents, the prodromal symptoms and any associated traumas during the one year follow-up were analyzed. Results: The syncopal rate was significantly lower in the period after the therapy initiation than before tilt testing (P<0.001). No differences were found in the gender structure,the prodromal syndrome rate between pacemaker and non-pacemaker patients, either in the number of syncope during follow-up. Pacemaker patients were older (P<0.01), characterised by the shorter syncopal history (P<0.001) and the higher number of syncope (P<0.05) with the magnitude of serious injuries. During follow-up syncope recurred in 5 (23%) of 22 pacemaker patients and in 3 (25%) of non-pacemaker patients (P>0.05). There was no trauma registered. Conclusions: The therapy, pharmacological or electrical, in cardiodepressive vasovagal patients with asystolereduces the number of syncope and injuries. Permanent pacing is the procedure for numerous patients with regard to age and malignant syncope. The optimal pacing algorithm is still in request.(Clin Exp Med Lett 2007; 48(1):29-31)

Keywords: Syncope, head-up tilt test, pacing therapy