title: Reflex vasovagal syncope--is there a benefit in pacemaker therapy?
abstract: Reflex vasovagal syncope often affects young populations and is associated with a benign prognosis in terms of mortality. However, a minority of patients have recurrent episodes, with a considerable impact on their quality of life. Pacemaker therapy has been an option in these patients since the 1990s if a conservative strategy fails. Initially, non-randomized and open-label randomized trials showed promising results, but these studies were associated with a significant placebo effect. Recently, an approach based on the use of implantable loop recorders has shown that some patients with reflex vasovagal syncope could benefit from implantation with dual-chamber pacemakers, particularly patients aged >40 years, with recurrent syncopal episodes resulting in frequent injuries, in whom a long asystole (≥3 s asystole with syncope or ≥6 s asystole without syncope) has been documented with an implantable loop recorder. The authors present a literature review on the role of cardiac pacing in reflex vasovagal syncope and propose a diagnostic and therapeutic decision flowchart for patients with syncope of probable reflex etiology.
authors.affiliation: Serviço de Cardiologia, Hospital de Faro, E.P.E., Faro, Portugal. Electronic address: Peter_senado2002@yahoo.com.
authors.forename: Pedro Alexandre
authors.initials: PA
authors.lastname: Sousa
authors.affiliation: Serviço de Cardiologia, Hospital de Faro, E.P.E., Faro, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Candeias
authors.affiliation: Serviço de Cardiologia, Hospital de Faro, E.P.E., Faro, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Marques
authors.affiliation: Serviço de Cardiologia, Hospital de Faro, E.P.E., Faro, Portugal.
authors.forename: Ilídio
authors.initials: I
authors.lastname: Jesus
mesh_terms: D003663:Decision Trees; D006801:Humans; D010138:Pacemaker, Artificial; D019462:Syncope, Vasovagal / Q000628:therapy*
keywords: Algoritmo de decisão; Decision flowchart; Detetor de eventos implantável; Dual‐chamber pacemaker; Implantable loop recorder; Pacemaker de dupla câmara; Reflex; Reflexa; Syncope; Síncope; Vasovagal