Successful use of Closed Loop Stimulation pacemaker for carotid sinus syndrome due to infiltrating neck cancer

A 64-year-old male with oropharyngeal carcinoma experienced recurrent syncope and hypotension due to neoplastic compression of the right carotid space. Despite initial treatment with atropine and fluid resuscitation, the patient continued to experience presyncope and hypotensive events. After treatment with a conventional dual-chamber pacemaker failed, the use of closed-loop stimulation (CLS) successfully resolved the syncope episodes. This case highlights the efficacy of CLS pacing in managing reflex syncope caused by extrinsic neoplastic compression of the carotid sinus. The CLS algorithm, by detecting pre-syncopal phases and increasing heart rate proactively, offers a significant advantage over conventional pacing in preventing syncope.