P453 RECURRENT SYNCOPAL EPISODES IN A YOUNG PATIENT: TO IMPLANT THE PM OR NOT TO IMPLANT THE PM, ALWAYS A DIFFICULT DECISION!

Abstract Introduction Syncope represents one of the main causes access to Emergency Department and outpatient visits, accounting for up 13% hospital admissions. Although usually benign, syncopal episodes are a source considerable distress patient family members, particularly when dealing with otherwise healthy young patients. We report case who presented recurrent important psychological professional implications. Case Report A 33–year–old man comes our Unit long history repeated preceded by fleeting warning signs, sometimes minor trauma, occurring during daily activities, in conjunction injuries or post–voiding but never exertion. The began limit his activities fear syncope was inhibited from driving work vehicles performing tasks at height. various cardiological examinations performed over years were normal. study evoked 13 sec pause on carotid sinus massage while Head–up Tilt Test negative. Loop Recorder (ILR) then implanted correlate any slowing pathological pauses heart rhythm. At remote monitoring ILR, an asystole about 16 seconds symptomatic documented. In relation recurring episodes, limitations imposed patient, as well explicit request himself, despite lacking scientific evidences availables, we proceeded implant dual–chamber pacemaker frequency response algorithm. 4 after there no recurrences resumed normal marked improvement also setting. After 2.5 years, however, ventricular lead broke required its extraction reimplantation. Conclusions decision device not easy, precisely possible complications this allowed resume private life. However, accurate risk–benefit assessment is required, sharing "weight" family.