2006, Number S2
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ABSTRACTVasovagal syncope is a common clinical problem forming the pathophysiological basis of half the cases of syncope. Although it usually has a favourable prognosis, it may be a highly limiting clinical problem in a particular subset of patients among whom syncopal recurrences are frequent and without prodromic symptoms, or have a traumatic outcome. For this subgroup of patients the term “malignant vasovagal syncope” has been proposed. The treatment of these highly symptomatic patients is necessary to avoid dangerous injuries and to improve the quality of life. Pacemaker therapy has been advocated as a potential therapy in severe or drug refractory cases. This paper reviews the concepts behind pacemaker therapy for vasovagal syncope and the results of various clinical trials that have evaluated its potential utility as a primary therapeutic modality.
FITZPATRICK AP, TRAVILL CM, VARDAS PE, HUBBARD WN, WOOD A, INGRAM A, SUTTON R: Recurrent symptoms after ventricular pacing in unexplained syncope. Pacing Clin Electrophysiol 1990; 13: 619-624.
KENNY RA, INGRAM A, BAYLESS J, SUTTON R: Head up-tilt: A useful test for investigating unexplained syncope. Lancet 1989; 1: 1352-1355.
FITZPATRICK A, SUTTON R: Tilting towards a diagnosis in recurrent unexplained syncope. Lancet 1989; 1: 658-660.
FITZPATRICK A, THEODORAKIS G, AHMED R: Dual chamber pacing aborts vasovagal syncope induced by head up 60° tilt. Pacing Clin Electrophysiol 1991; 14: 13-19.
MCGUINN P, MOORE S: Temporary dual chamber pacing during tilt table testing for vasovagal syncope: predictor of therapeutic success (Abstract). Pacing Clin Electrophysiol 1991; 14: 734-738.
SAMOIL D, GRUBB BP, BREWSTER P: Comparison of single and dual chamber pacing techniques in the prevention of upright tilt-induced vasovagal syncope. Eur J Card Pacing Electrophysiol 1993; 3: 36-41.
SRA J, JAZAYERI M, AVITALL B: Comparison of cardiac pacing with drug therapy in the treatment of neurocardiogenic syncope with bradycardia or asystole. New Engl J Med 1993; 328: 1085-1090.
PETERSEN ME, CHAMBERLAIN-WEBER R, FITZPATRICK A, INGRAM A, WILLIAMS T, SUTTON R: Permanent pacing for prevention of recurrent vasovagal syncope. Br Heart J 1994; 71: 274-281.
CONNOLLY SJ, SHELDON R, ROBERTS RS, GENT M: The North American vasovagal pacemaker study (VPS): a randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. J Am Coll Cardiol 1999; 33: 16-20.
AMMIRATI F, COLIVICCHI F, TOSCAZO S, PANDOZI C, LAUDADIO MT, DE SETA F, SANTINI M: DDP pacing with rate-drop function versus DDI with rate hysteresis pacing for cardioinhibitory vasovagal syncope. Pacing and Clin Electrophysiol 1998; 21: 2178-2181.
AMMIRATI F, COLIVICCHI F, SANTINI M: Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope: a multicentre, randomized controlled trial. Circulation 2001; 104: 52-57.
CONNOLLY S, SHELDON R, THORPE K, ET AL: Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope. Second vasovagal pacemaker study (VPSII): a randomized trial. JAMA 2003; 289: 2224-2229.
GIADA F, RAVIELE A, MENOZZI C, ET AL: The vasovagal syncope and pacing trial (SYNPACE):a randomized placebo controlled study of permanent cardiac pacing for treatment of recurrent vasovagal syncope. Pacing and Clin Electrophysiol 2003; 26: 1016.
OCCHETA E, BORTNIK M, AUDOGLIO R, VASSANELLI C, for the INVASY Study Investigators: Closed loop stimulation in prevention of vasovagal syncope (INVASY): a multicentre randomized, single blind, controlled study. Europace 2004; 6: 538-547.