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Recurrent Symptoms after Ventricular Pacing in Unexplained Syncope
Author(s) -
FITZPATRICK ADAM P.,
TRAVILL CHRISTOPHER M.,
VARDAS PANOS E.,
HUBBARD WILLIAM N.,
WOOD ANGUS,
INGRAM ANN,
SUTTON RICHARD
Publication year - 1990
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1990.tb02078.x
Subject(s) - medicine , syncope (phonology) , cardiology , vasovagal syncope , asymptomatic , tilt table test , hemodynamics , intracardiac injection , bradycardia , sick sinus syndrome , sinus bradycardia , anesthesia , heart rate , blood pressure
We report clinical and hemodynamic data in two cases of recurrent syncope. Both patients received permanent demand ventricular pacing (VVI) for unexplained syncope. Both patients experienced recurrent syncope after pacemaker implantation. They later underwent 60° head‐up tilt testing, initially noninvasively and then with hemodynamic profile. A vasovagul response fo lilt occurred with bradycardia and was complicated by the onset of ventricular pacing and retrograde atrioventricular conduction (RAVC) with hemodynamic deterioration and rapid reproduction of syncope. Limited intracardiac electrophysiofogical study (EPS) excluded atrioventricular (AV) conduction disease, sinus node disease, and carotid sinus syndrome, and confirmed RAVC. Both patients were upgraded to dual chamber pacing, DDI mode, with 50/80 rate hysteresis. One patient was asymptomatic at repeat tilt testing; the other experienced continued symptoms due to the vasodepressor component of vasovagal syncope. Cardiac pacing alone is ineffective treatment for this phenomenon, and no proven therapy is presently available. Ventricular pacing applied to patients with unexplained syncope may lead to an increase in or continuation of symptoms rather than an amelioration. There is a need for full investigation of such patients, which must include tilt testing, to allow for the most accurate diagnosis possible and guide the most appropriate therapy.