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Pacing in neurocardiogenic/vasovagal syncope.
1National Heart and Lung Institute, Hammersmith Hospital Campus, B block South, 2nd floor, NHLI-Cardiovascular Science, Imperial College, Du Cane Road, W12 0NN, London, UK. r.sutton@imperial.ac.uk.
Herzschrittmachertherapie & Elektrophysiologie
|May 27, 2018
Summary
Pacing may benefit select patients with neurocardiogenic or vasovagal syncope (VVS) when standard treatments fail. Identifying these patients using ECG loop recorders and tilt testing improves outcomes.
Area of Science:
- Cardiology
- Neuroscience
Background:
- Pacing for vasovagal syncope (VVS) has a long history, initially based on tilt testing revealing asystole.
- Early studies suggested pacing benefits, but flawed trial designs yielded inconclusive results.
Purpose of the Study:
- To identify patient selection criteria for effective pacing in VVS.
- To evaluate the role of ECG loop recorders and tilt testing in optimizing pacing outcomes.
Main Methods:
- Two studies utilized ECG loop recorders to document arrhythmias during spontaneous syncope events.
- A randomized controlled trial (RCT) incorporated tilt testing for enhanced patient selection.
- Dual-chamber pacing was recommended for older patients (>40 years) with severe, refractory symptoms.
Main Results:
- ECG loop recorders identified patients with asystole during spontaneous attacks, improving pacing selection.
- Tilt testing provided additional benefit in identifying patients who would respond to pacing.
- Dual-chamber pacing is suggested for specific patient groups with severe VVS.
Conclusions:
- Combining ECG loop recorders and tilt testing aids in selecting VVS patients who benefit from pacing.
- Dual-chamber pacing is a viable option for older patients with severe, intractable VVS.
- Optimal pacing strategies and triggers require further investigation.
