[Syncope of unknown origin in patients with permanent auriculoventricular block with an implanted pacemaker....

Four female patients aged 26 to 71 years, with permanent complete AV heart block and an implanted pacemaker had syncope or presyncope after the pacemaker implantation. As part of the study protocol the tilt table test was done. Neurological disease, arrhythmias, pacemaker syndrome or dysfunction of the stimulation system were ruled out. A head up tilt was performed, isosorbide was used as pharmacological challenge, since the basal test was negative. In three patients this test was positive: in one patient possibly caused by postural orthostatic tachycardia syndrome, and two with neurally mediated syncope. In one patient it was not possible a diagnosis. The head-up tilt test is a useful procedure to identify the etiology of the appearance of syncope or presyncope after a pacemaker implantation in patients with complete and permanent AV block.