Reproducibility of tilt-table test result in patients with malignant neurocardiogenic syncope.
The indication for permanent pacemaker remains controversial in malignant neurocardiogenic syncope. A highly reproducible prolonged pause during a repeat head-up tilt-table testing may identify a subgroup of neurally mediated syncope with a prominent and consistent cardioinhibitory component. Seven patients (3 females) with a mean age of 30 years (23-44 years) were diagnosed to have malignant neurocardiogenic -syncope; all are classified according to the Vasovagal Syncope International Study as 2B type, with observed sinus pauses ranged from 3 s to 26 s of which only 1 demonstrated a reproducible sinus pause. No recurrence of syncope was clinically observed in patients during the follow-up period. Of 6 patients treated non--pharmacologically, one required a beta-blocker and none required a permanent pacemaker. Prolonged asystole manifest during head-up tilt-table testing is a poorly reproducible phenomenon and permanent pacemaker implantation in malignant neurocardiogenic syncope should not be a first line therapy.
Cardiac Department, National University Hospital, Singapore.
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Sutandar
D000328:Adult; D002317:Cardiovascular Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D019462:Syncope, Vasovagal / Q000175:diagnosis* / Q000188:drug therapy; D018667:Tilt-Table Test
D002317:Cardiovascular Agents