Pacing for neurally-mediated syncope: How to decide?
نویسنده
چکیده
Neurally-mediated syncope has a broad clinical spectrum which ranges from typical vasovagal syncope on one hand, to those situations in which reflex syncope occurs with uncertain, or even apparently absent, triggers or prodromes, on the other hand. Overlap of clinical features is frequent in clinical practice and makes any classification difficult to apply when selecting patients for cardiac pacing. Typically, the reflex is both hypotensive and cardio-inhibitory. The rationale for efficacy of cardiac pacing is that the cardio-inhibitory reflex is dominant, since there is no role for pacing in preventing vasodilatation and hypotension. Establishing a relationship between symptoms and cardio-inhibitory reflex should be the goal of the clinical evaluation before embarking on permanent pacing. Similar efficacy has been observed in patients affected by dominant cardio-inhibitory reflex irrespective of the clinical form. In general, cardiac pacing should be considered last choice applied only in highly selected patients, i.e. those ≥ 40 years of age, affected by severe forms of reflex syncope with recurrences associated with frequent injury, often due to the lack of prodromes. Recurrence of syncope may still occur despite cardiac pacing in a minority of patients.
منابع مشابه
Cardiac pacing for severe childhood neurally mediated syncope with reflex anoxic seizures.
OBJECTIVE To determine whether permanent cardiac pacing could prevent syncope and seizures in children with frequent severe neurally mediated syncope, and if so whether dual chamber pacing was superior to single chamber ventricular pacing. METHODS Dual chamber pacemakers were implanted into 12 children (eight male, four female) aged 2-14 years (median 2.8 years) with frequent episodes of refl...
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متن کاملPacemaker therapy in patients with neurally mediated syncope and documented asystole: Third International Study on Syncope of Uncertain Etiology (ISSUE-3): a randomized trial.
BACKGROUND The efficacy of cardiac pacing for prevention of syncopal recurrences in patients with neurally mediated syncope is controversial. We wanted to determine whether pacing therapy reduces syncopal recurrences in patients with severe asystolic neurally mediated syncope. METHODS AND RESULTS Double-blind, randomized placebo-controlled study conducted in 29 centers in the Third Internatio...
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ورودعنوان ژورنال:
- Cardiology journal
دوره 21 6 شماره
صفحات -
تاریخ انتشار 2014