Pacing may not prevent neurocardiogenic syncope: the importance of correct diagnosis.
A 28-year-old female with frequent attacks of syncope showed high degree atrioventricular (AV) block in Holter's electrocardiographic monitoring. A permanent pacemaker (VVIR) was implanted. However, the syncope recurred despite the normally-functioning pacemaker. The syncope associated with hypotension and bradycardia was reproduced by upright posture for 8 min. This neurocardiogenic syncope was prevented by propranolol (30 mg/day). Neurocardiogenic syncope should be ruled out before pacemaker implantation in patients with syncope, particularly in young adults with no apparent symptom/electrocardiography correlation.
Ko
C C
CC
Department of Medicine, Veterans General Hospital-Kaohsiung, Taiwan, ROC.
Hou
Z Y
ZY
Chiou
C W
CW
Chen
C Y
CY
D000328:Adult; D001919:Bradycardia / Q000150:complications / Q000175:diagnosis; D015716:Electrocardiography, Ambulatory; D005260:Female; D006327:Heart Block / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis / Q000209:etiology; D010138:Pacemaker, Artificial; D011433:Propranolol / Q000627:therapeutic use; D013575:Syncope / Q000209:etiology* / Q000628:therapy
D011433:Propranolol