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The Etiology of Syncope in Pacemaker Patients
Author(s) -
PAVLOVIC SINISA U.,
KOCOVIC DUSAN,
DJORDJEVIC MILAN,
BELKIC KAREN,
KOSTIC DUSAN,
VELIMIROVIC DUSAN
Publication year - 1991
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.1540-8159.1991.tb06478.x
Subject(s) - medicine , orthostatic vital signs , cardiology , blood pressure , syncope (phonology) , vasovagal syncope , presyncope , tilt table test , fainting , atrioventricular block , etiology , anesthesia , heart rate
A total of 46 patients with syncopal episodes after VVI pacemaker implantation were studied. Of these, 92% had one to three syncopal episodes and 8% more than three. All underwent a thorough clinical examination, which included chest X ray, echocardiogram, neurological exam, and the following protocol: 24‐hour Holler monitoring, EEG, blood pressure (BP) measurement in three positions, Doppler exam of the carotid vessels, fasting blood glucose, and head‐up tilt table test (60 minutes, 60°). Holter monitoring showed exit block in two patients (4.3%) and failed sensing in one (2.1%). In two patients there was unilateral slowing on EEG. Orthostatic hypotension was found in four patients (8.6%), and hypoglycemia in three insulin‐dependent diabetics. An ocdusive atherosclerotic plaque in the carotid artery was found in three patients (6,5%). Syncope was induced in 17 patients (36,9%) by the tilt table test, after a mean standing time of 47 ± 11 minutes. The mean resting systolic BP of these patients was 140 ± 24 mmHg, and fell to a mean level of 56 ± 8 mmHg (mean systolic BP drop was 79 ± 8 mmHg). Sixteen of these 17 patients with positive tilt table were being paced at the time of syncope and one had a spontaneous heart rate of 73 beats/min. In 14 cases (30.4%) the cause of syncopai episodes after this extensive workup remained unexplained. These results indicate that pacemaker dysfunction is a not major cause of syncopal episodes in pacemaker patients and that these are most often due to vasovagal syncope. Long‐term follow‐up is warranted to determine the prognostic significance of various types of syncope in pacemaker patients.