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Cardiac pacing does not improve orthostatic tolerance in patients with vasovagal syncope

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Abstract

This study was undertaken to assess the value of dual chamber pacing in the treatment of vasovagal syncope. In a preliminary study, on two patients the time to presyncope during head-up tilt before and after implanting pacemakers was determined. Both patients fainted with similar decreases in blood pressure at almost exactly the same time after tilting. In the main study, nine patients with pacemakers implanted as treatment for syncope were studied, in random order, with pacemakers on and either off or turned to minimum rate. The pacemakers prevented bradycardia but had no effect on the time to syncope in a progressive test of head-up tilt followed by the addition of graded lower body suction. It is concluded that cardiac pacing does not prevent or even delay the onset of postural syncope and infer that bradycardia is an unimportant component of vasovagal attacks.

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References

  1. Day SC, Cook EF, Funkenstein H, Goldman L. Evaluation and outcome of emergency room patients with transient loss of consciousness.Am J Med 1982;73: 15–23.

    PubMed  Google Scholar 

  2. Gendelman HE, Linzer M, Gabelman H, Smaller S, Schewer J. Syncope in a general hospital patient population.NY State J Med 1983;83: 1161–1165.

    Google Scholar 

  3. Kapoor WN, Karpf M, Wieand S, Peterson J, Levey GS. A prospective evaluation and follow-up of patients with syncope.N Engl J Med 1983;309: 197–204.

    PubMed  Google Scholar 

  4. Abi-Samra F, Maloney JD, Fouad-Tarazi FM, Castle LM. The usefulness of head-up tilting and hemodynamic investigations in the work-up of syncope of unknown origin.Pace 1988;11: 1202–1214.

    PubMed  Google Scholar 

  5. Wahbha MMAE, Morley CA, Al-Shamma YMH, Hainsworth R. Cardiovascular reflex responses in patients with unexplained syncope.Clin Sci 1989;77: 547–553.

    PubMed  Google Scholar 

  6. Lewis T. Vasovagal syncope and the carotid sinus mechanism.Br Med J 1932;1: 873–876.

    Google Scholar 

  7. Barcroft H, Edholm OG. On the vasodilatation in human skeletal muscle during post-haemorrhagic fainting.J Physiol 1945;104: 161–175.

    Google Scholar 

  8. Barcroft H, McMichael J, Sharpey-Shafer EP. Post-haemorrhagic fainting. Study by cardiac output and forearm blood flow.Lancet 1944;1: 480–491.

    Google Scholar 

  9. Hainsworth R. Syncope and fainting. In: Bannister R, Mathias CJ (eds.)Autonomic Failure: A Textbook of Clinical Disorders of the Autonomic System. 3rd edn. Oxford: Oxford University Press, 1992: 761–781.

    Google Scholar 

  10. Maloney TD, Jaeger FJ, Fouad-Tarazi FM, Morris HH. Malignant vasovagal syncope: prolonged asystole provoked by head-up tilt.Cleveland Clin J Med 1988;55: 542–548.

    Google Scholar 

  11. Fitzpatrick A, Sutton R. Tilting towards a diagnosis in recurren unexplained syncope.Lancet 1989;i: 658–660.

    Google Scholar 

  12. Raviele A, Gasparini DPF, Delise P, Basso A, Piccolo E. Usefulness of head-up tilting in evaluating patients with syncope of unknown origin and negative electrophysiological study.Am J Cardiol 1990;65: 1322–1327.

    PubMed  Google Scholar 

  13. El-Bedawi KM, Hainsworth R. Combined head-up tilt and lower body suction: a test of orthostatic tolerance.Clin Auton Res 1994;4: 41–47.

    PubMed  Google Scholar 

  14. Hainsworth R, Al-Shamma YMH. Cardiovascular responses to upright tilting in healthy subjects.Clin Sci 1988;74: 17–22.

    PubMed  Google Scholar 

  15. Hainsworth R, El-Bedawi KM. Orthostatic tolerance in patients with unexplained syncope.Clin Auton Res 1994;4: 239–244.

    PubMed  Google Scholar 

  16. Wallin BG, Sundlof G. Sympathetic outflow in muscles during vasovagal syncope.J Auton Res 1982;6: 287–291.

    Google Scholar 

  17. Hainsworth R. Non-invasive investigations of cardiovascular reflexes in humans.Clin Sci 1990;78: 437–443.

    PubMed  Google Scholar 

  18. Almquist A, Gornick C, Benson DW Jr, Dunnigan A, Benditt DG. Carotid sinus hypersensitivity: evaluation of the vasodepressor component.Circulation 1985;71: 927–936.

    PubMed  Google Scholar 

  19. Kus T, Lalonde G, Champlain JD, Shenasa M. Vasovagal syncope: management with atrioventricular sequential pacing and beta-blockade.Can J Cardiol 1989;5: 375–378.

    PubMed  Google Scholar 

  20. Sra JS, Jazayeri MR, Avitall B, Dhala A, Deshpande S, Blanck Z, Akhtar M. Comparison of cardiac pacing with drug therapy in the treatment of neurogenic (vasovagal) syncope and bradycardia or asystole.N Engl J Med 1993;328: 1085–1090.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. The Research School of Medicine (Cardiovascular Studies), University of Leeds, LS2 9JT, Leeds, UK

    K. M. El-Bedawi, M. M. A. E. Wahbha & R. Hainsworth

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  1. K. M. El-Bedawi
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  2. M. M. A. E. Wahbha
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  3. R. Hainsworth
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El-Bedawi, K.M., Wahbha, M.M.A.E. & Hainsworth, R. Cardiac pacing does not improve orthostatic tolerance in patients with vasovagal syncope. Clinical Autonomic Research 4, 233–237 (1994). https://doi.org/10.1007/BF01827427

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  • DOI: https://doi.org/10.1007/BF01827427

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