Pacemaker Therapy for Prevention of Syncope in Patients With Recurrent Severe Vasovagal Syncope

Abstract

ASOVAGAL SYNCOPE, ALSO known as neurally mediated syncope, is a common problem for which no highly effective pharmacological treatments are available. Because vasovagal syncope episodes are often associated with bradycardia, pacemakers have been proposed as a potential treatment. After some uncontrolled follow-up studies reported a benefit, 1,2 3 small randomized controlled trials of pacemaker therapy were performed. 3-5 All 3 trials reported a reduction in syncope recurrence with pacing. However, treatment in all 3 studies was not blinded, such that patients and their physicians knew whether the patient had received a pacemaker. It is possible that the reported benefit of pacemaker therapy was due in part to a psychological or emotional effect related to receiving a device by means of an

Syncope While Driving

“…The syncope recurrence rate in the driving group in our study is lower than that in an earlier prospective study of syncope by Kapoor (33), which showed a 61% recurrence rate within 1 year and 82% within 2 years. The recurrence rate of syncope in our study cohort is closer to data from younger patients with vasovagal syncope from recent randomized trials (≈30%-40% at 1 year) (34-36). These differences could be explained on the basis of different patient selection and therapeutic interventions.…”

Role of head‐up tilt table testing in patients with syncope or transient loss of consciousness

“…Previous randomized controlled trials guided by TTT responses could not demonstrate the effectiveness of pacing therapy in patients with tilt-induced syncope due to long asystole [15] , [16] , [17] , [18] . The International Study on Syncope of Uncertain Etiology 3 demonstrated the effectiveness of pacing therapy in patients with asystole, documented using implantable cardiac monitors [19] .…”

Placebo Control and Blinding in Randomized Trials of Procedural Interventions

“…From this sample, a total of 97 end points were identified, for which paired data meeting full inclusion criteria were available from at least 1 blinded and at least 1 unblinded trial (Table 1). These data were obtained from 72 blinded and 55 unblinded trials, incorporating 111 500 patient data points: 51 688 in blinded trials and 59 812 in unblinded trials.…”