Skip to main content

To Pace or not to Pace for Neurally Mediated Syncope: Do We Know the Answer? A Positive View

  • Conference paper
Cardiac Arrhythmias 2003
  • 55 Accesses

Abstract

Single chamber VVI mode pacing proved to be ineffective in vasovagal syncope treatment [1], while several nonrandomized studies [2–4] showed a significant decrease in recurrence in patients who underwent dual chamber pacing. In the last few years, three randomized, noncontrolled studies have shown the efficacy of dual-chamber pacemaker implantation in reducing recurrence in patients with recurrent neuromediated syncope. The VPS study [5] demonstrated the effectiveness of rate-drop response pacemakers in patients affected by neurally mediated syncope who gave a positive response in the tilting test, presenting a varying cardoinhibitory component. The VASIS study [6], on the other hand, showed the effectiveness of a DDI-mode pacemaker with hysteresis in patients with neurally mediated syncope and positive tilting test with a marked cardoinhibitory component. Finally, the SYDIT trial [7] reported the superiority of pacemaker implantation over drug treatment with ß-blockers.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Benditt DG, Petersen M, Lurie KG et al (1995) Cardiac pacing for the prevention of recurrent vasovagal syncope. Ann Intern Med 122:204–209

    PubMed  CAS  Google Scholar 

  2. Petersen MEV, Chamberlain-Webber R, Fitzpatrick AP et al (1994) Permanent pacing for cardioinhibitory malignant vasovagal syndrome. Br Heart J 71:274–281

    Article  PubMed  CAS  Google Scholar 

  3. Benditt DG, Sutton R, Gammage M, Fetter J, Markowitz T and the Rate-Drop Response Investigators (1997) Clinical experience with Thera DR rate drop response pacing algorithm in carotid sinus syndrome and vasovagal syncope. Pacing Clin Electrophysiol 20:832–839

    Article  PubMed  CAS  Google Scholar 

  4. Sheldon R, Koshman ML, Wilson W et al (1998) Effect of dual chamber pacing with automatic rate-drop sensing on recurrent neutrally mediated syncope. Am J Cardiol 81:158–162

    Article  PubMed  CAS  Google Scholar 

  5. Connolly SJ, Sheldon R, Roberts RS, Gent M (1999) The North American Vasovagal Pacemaker Study (VPS). A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. J Am Coll Cardiol 33:16–20

    Article  CAS  Google Scholar 

  6. Sutton R, Brignole M, Menozzi C et al on behalf of the Vasovagal Syncope International Study (VASIS) Investigators (2000) Dual-chamber pacing is efficacious in treatment of neurally-mediated tilt-positive cardioinhibitory syncope. Pacemaker versus no therapy: a multicentre randomized study. Circulation 102:294–299

    Article  PubMed  CAS  Google Scholar 

  7. Ammirati F, Colivicchi F, Santini M et al (2001) Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope. Circulation 104:52–57

    Article  PubMed  CAS  Google Scholar 

  8. Connolly SJ, Sheldon R, Thorpe KE et al (2003) Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope (VPS II): a randomized trial. JAMA 289:2224–2229

    Article  PubMed  Google Scholar 

  9. Giada F, Raviele A, Menozzi C et al (2003) The Vasovagal Syncope and Pacing Trial (Synpace). A randomized, placebo-controlled study of permanent cardiac pacing for the treatment of recurrent vasovagal syncope. Pacing Clin Electrophysiol

    Google Scholar 

  10. Deharo JC, Peyre JP, Chalvidian T et al (2000) Continuous monitoring of an endocar-dial index of myocardial contractility during head-up tilt test. Am Heart J 139:1022–1030

    Article  PubMed  CAS  Google Scholar 

  11. Kurbaan AS, Erikson M, Petersen MEV et al (2000) Respiratory changes in vasovagal syncope. J Cardiovasc Electrophysiol 11:607–611

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2004 Springer-Verlag Italia

About this paper

Cite this paper

Giada, F., Raviele, A. (2004). To Pace or not to Pace for Neurally Mediated Syncope: Do We Know the Answer? A Positive View. In: Raviele, A. (eds) Cardiac Arrhythmias 2003. Springer, Milano. https://doi.org/10.1007/978-88-470-2137-2_85

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2137-2_85

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2177-8

  • Online ISBN: 978-88-470-2137-2

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics