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Pacing for vasovagal syncope: Tips for use in practice.

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Summary

Cardiac pacing effectively treats vasovagal syncope (VVS) in patients with a strong cardio-inhibitory response. This review offers practical guidance on selecting appropriate candidates for this proven therapy.

Keywords:
Cardio-inhibitionHead-up tiltPacingSyncopeVasovagal

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Area of Science:

  • Cardiology
  • Neurology

Background:

  • Vasovagal syncope (VVS) is the most common cause of syncope across all age groups.
  • Recurrent, refractory VVS with a significant cardio-inhibitory response is a challenging clinical problem.

Purpose of the Study:

  • To provide practical guidance on the use of cardiac pacing for selected patients with vasovagal syncope.
  • To highlight the efficacy of cardiac pacing for the cardio-inhibitory phenotype of VVS.

Main Methods:

  • Review of recent randomized double-blinded trials (RCTs) supporting pacing in VVS.
  • Discussion of head-up tilt testing (HUTT) for documenting cardio-inhibitory responses.
  • Focus on practical considerations for patient selection and pacing implementation.

Main Results:

  • Cardiac pacing is the only proven therapy for the cardio-inhibitory phenotype of VVS.
  • RCTs reinforce the benefit of pacing in carefully selected VVS patients.
  • Head-up tilt testing can document the need for pacing.

Conclusions:

  • Cardiac pacing offers a proven therapeutic option for specific VVS patients.
  • Careful patient selection is crucial for successful pacing outcomes.
  • Further clarification on optimal candidate selection for pacing in VVS is needed.