creators_name: Wijesekera, Nevin T
creators_name: Kurbaan, Arvinder S
editors_name: Singh, Balbir
editors_name: Lokhandwala, Yash
editors_name: Francis, Johnson
editors_name: Gupta, Anup
type: journalp
datestamp: 2005-05-02
lastmod: 2011-03-11 08:56:01
metadata_visibility: show
title: Pacing for Vasovagal Syncope
ispublished: pub
subjects: ipej
full_text_status: public
keywords: Pacing; Vasovagal Syncope
abstract: Vasovagal syncope is a common condition, usually associated with a benign prognosis. Most sufferers experience only occasional symptoms, and can be treated with reassurance and lifestyle advice. However, a minority of patients are debilitated by frequent fainting that can infringe on daily living, or even mimic sudden death. This has been termed "malignant" vasovagal syncope because of the associated falls and physical injury. In these cases, a more interventional approach may be appropriate.
            Pharmacological measures have been the mainstay of treatment for recurrent vasovagal syncope: beta-blockers (e.g. atenolol), serotonin reuptake inhibitors (e.g. paroxetine), certain vasoconstricting drugs (e.g. midodrine) and fluid retaining agents (e.g. fludrocortisone) have been of particular interest. However, there is only mixed support from randomised controlled trials for the efficacy of these agents in preventing vasovagal syncope. 1,2,3
            In the last few years, cardiac pacing has been advocated for the treatment of some forms of vasovagal syncope. This article reviews the literature and discusses the indications for pacing in vasovagal syncope. 

date: 2002-10
date_type: published
publication: Indian Pacing and Electrophysiology Journal
volume: 2
number: 4
publisher: Indian Pacing and Electrophysiology Group
pagerange: 114-119
refereed: TRUE
referencetext: 1. Sutton R. Is there an effective pharmacological treatment in the prevention of vasovagal syncope? Arch Mal Coeur 1996;89:25-28.

2. Mahanonda N, Bhuripanyo K, Kangkagate C et al. Randomised double blind placebo controlled trial of oral atenolol in patients with unexplained syncope and positive upright tilt table results. Am Heart J 1995;130:1250-1253. 

3. Madrid A, Ortega J, Rebollo J et al. Lack of efficacy of atenolol for the prevention of neurally mediated syncope in a highly symptomatic population: A prospective, double-blind, randomised and placebo-controlled study. J Am Coll Cardiol 2001;37:554-559.

4. Clarke M, Sutton R, Ward D et al. British Pacing and Electrophysiology Group working Party. Recommendations for pacemaker prescription for symptomatic bradycardia. Br Heart J 1991;66:185-191.

5. Gregartos G, Cheitlin MD, Conill A et al. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation). Circulation 1998;98:1325-1335.

6.  Fitzpatrick A, Theodorakis G, Ahmed R et al. Dual-chamber pacing aborts vasovagal syncope induced b head-up 60 degree tilt. PACE 1991;14:13-19.

7.  Samoil D, Grubb B, Brewster P et al. Comparison of single and dual-chamber pacing techniques in prevention of upright tilt-induced vasovagal syncope. Eur J Cardiac Pacing Electrophysiol 1993;3:36-41.

8.  Sra J, Jazayeri M, Avitall B et al. Comparison of cardiac pacing with drug therapy in the treatment of neurocardiogenic (vasovagal) syncope with bradycardia or asystole. N Engl J Med 1993;328:1085-1090.

9.  Peterson M, Chamberlain-Webber R, Fitzpatrick A et al. Permanent pacing for cardioinhibitory malignant vasovagal syndrome. Br Heart J 1994;71:274-281.

10.  Benditt D, Sutton R, Gammage M et al. Clinical experience with Thera DR rate-drop response pacing algorithm in carotid sinus syndrome and vasovagal syncope. The International Rate-Drop Investigators Group. Pacing Clinic Electrophysiol 1997;20:832-839.

11.  Sheldon R, Koshman M, Wilson W et al. Effect of dual-chamber pacing with automatic rate-drop sensing on recurrent neurally medicated syncope. Am J Cardiol 1998;81:158-162.

12.  Raj S, Sheldon R. Permanent cardiac pacing to prevent vasovagal syncope. Curr Opin Cardiol 2002;17:90-95.

13.  Connolly S, Sheldon R, Roberts R et al. the North American Vasovagal Pacemaker Study (VPS). A randomised trial of permanent cardiac pacing or the prevention of vasovagal syncope. J Am Coll Cardiol 1999;33:16-20.

14. Sutton R, Brignole M, Menozzi C et al. Dual-chamber pacing in the treatment of neurally mediated tilt-positive cardioinhibitory syncope; pacemaker versus no therapy - a multicoated randomised study. The Vasovagal Syncope International study (VASIS) Investigators. Circulation 2000;102:294-299.

15. Ammirati F, Colivicchi F, Santini M. Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope: a multicentre, randomised, controlled trial. Circulation 2001;104:52-57.

16.  Ammirati F, Colivicchi F, Toscano S et al. DDD pacing with rate drop response function versus DDI with rate hysteresis pacing for cardioinhibitory vasovagal syncope syncope. Pacing Clin Electrophysiol 1998;21:2178-2191.

17. Kurbaan A, Erickson M, Peterson M et al. Respiratory changes in vasovagal syncope. J Cardiovasc Electrophysiol 2000;11:607-611.

18. Fitzpatrick A, Travill C, Vardas P et al. Recurrent symptoms after ventricular pacing in unexplained syncope. PACE 1994;13:619-629.

19.  McLeod K, Wilson N, Hewitt J et al. Cardiac pacing for severe childhood neurally mediated syncope with reflex anoxic seizures. Heart 1999;82:721-725.

20. Kurbaan A, Franzen A, Stack Z et al. Is there an optimal pacing intervention rate for vasovagal syncope? PACE 1999;22:707.

21. Sutton R, Bloomfield D. Indications, methodology, and classification of results of tilt table testing. Am J Cardiol 1999;84:10-19.

22. Moya A, Brignole M, Menozzi C et al. Mechanism of syncope in patients with isolated syncope and in patients with tilt-positive syncope. The International Study on Syncope of Uncertain Etiology Investigators. Circulation 2001;104:1261-1267

23. Giada F, Raviele A, Gasparini G et al. Efficacy of a patient-activated drug delivery system using phenylephrine as active drug in aborting tilt-induced syncope [abstract]. Pacing Clin Electrophysiol 2001;24:573.
citation:   Wijesekera, Nevin T and Kurbaan, Arvinder S  (2002) Pacing for Vasovagal Syncope.  [Journal (Paginated)]     
document_url: http://cogprints.org/4300/1/kurbaan.htm