Syncope, pacemakers treatment

Sutton R, Brignole M, Menozzi C et al. for the Vasovagal Syncope International Study (VASIS) Investigators Dual-chamber pacing in the treatment of neuraUy mediated tilt-positive cardioinbibitory syncope pacemaker versus no therapy a multicenter randomized study. Circulation 102(3), 294—299 (2000). 

A 32-year-old woman took 800 mg of citalopram, 20 times her usual daily dose, in a suicide attempt. On admission to hospital she had a sinus bradycardia (41/ minute) but the electrocardiogram was otherwise normal, with a QT interval of 430 ms. Treatment with atropine failed to increase her heart rate and she had hypotension and syncope. A temporary pacemaker was inserted and was required for the next 6 days before it could be safely removed. 

Soon after the start of donepezil treatment three patients with Alzheimer s disease developed cardiac syncope (52). In two cases, a bradydysrhythmia was documented and pacemaker implantation was considered justified rather than donepezil withdrawal. 

There is perhaps no other treatment modality that is more controversial than the role of permanent cardiac pacing. Some episodes of NCS, both spontaneous and tilt-induced, are associated with profound bradycardia or asystole which led to the impetus to test pacemakers as therapy. There have been numerous trials on pacing in syncope, the results of which have been mixed. This has led to a certain degree of uncertainty regarding the role pacemakers can play in syncope if any at all. 

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