Prevention of Vasovagal Syncope by Pacing: How to Select Patients and Which Pacing Mode to Choose

Abstract

Despite the fact that vasovagal syncope is probably the most frequent of all causes of fainting, treatment strategies are as yet still based on an incomplete understanding of the pathophysiology of the faint. On the other hand, given the frequency with which the vasovagal syncope occurs, there is a wealth of clinical experience on which to draw. In the vast majority of cases, patients who seek medical advice after having experienced a vasovagal faint principally require reassurance and education regarding the nature of the condition. This assumption is derived from the knowledge of the benign nature of the disorder In particular, on the basis of a review of their medical history, patients should be informed of the likelihood of syncope recurrence. Initial advice should also include a review of typical premonitory symptoms, which may permit many individuals to recognize an impending episode and thereby avert a frank faint. Additional common sense measures such as avoidance of volume depletion and prolonged exposure to upright posture and/or hot, confining environments should also be discussed. In regard to these latter treatment concepts, formal randomized studies are not available, but physiological evidence and clinical experience are sufficient warrant.