Pacing for Vasovagal Syncope: Real Efficacy or Placebo Effect?

Abstract

The American College of Cardiology/American Heart Association Task Force [1] and the British Pacing and Electrophysiology Group [2] recommend permanent pacing as treatment for neurally mediated syncope. What is the evidence that supports these recommendations? Unquestionably, fainting is a substantial problem for many of our patients and merits attempts at treatment. Although many believe that fainting is a transitory phase that passes, and that the severity of symptoms is minimal, this is far from the rule. Several studies reported that patients had medians of 5–15 syncopal spells, and had been fainting for of 2–10 years [3–9]. Many patients faint several times a year. Therefore vasovagal syncope can occur frequently, and it can be a problem that lasts many years. Not surprisingly, patients with frequent vasovagal syncope have a poor quality of life. Patients with recurrent syncope are impaired to a similar extent as those with severe rheumatoid arthritis or chronic low back pain, and as psychiatric inpatients [10]. The quality of life decreases as the frequency of syncopal spells increases [11]. Although some patients do respond to drug therapy, many do not, and for them treatment with a permanent pacemaker is often considered.