Srpski arhiv za celokupno lekarstvo 2016 Volume 144, Issue 11-12, Pages: 597-601
https://doi.org/10.2298/SARH1612597R
Full text ( 167 KB)
Is pacemaker therapy the right key to patients with vasovagal syncope?
Radovanović Nikola N. (Clinical Center of Serbia, Pacemaker Center, Belgrade)
Kirćanski Bratislav (Clinical Center of Serbia, Pacemaker Center, Belgrade)
Raspopović Srđan (Clinical Center of Serbia, Pacemaker Center, Belgrade)
Pavlović Siniša U. (Clinical Center of Serbia, Pacemaker Center, Belgrade + School of Medicine, Belgrade)
Jovanović Velibor (Clinical Center of Serbia, Pacemaker Center, Belgrade)
Milašinović Goran (Clinical Center of Serbia, Pacemaker Center, Belgrade + School of Medicine, Belgrade)
Introduction. Vasovagal syncope is the most common type of reflex syncope.
Efficacy of cardiac pacing in this indication has not been the subject of
many studies and pacemaker therapy in patients with vasovagal syncope is
still controversial. Objective. This study aimed to assess the efficacy and
safety of pacing therapy in treatment of patients with vasovagal syncope, to
determine contribution of new therapeutic models in increasing its success,
and to identify risk factors associated with a higher rate of symptoms after
pacemaker implantation. Methods. A retrospective study included 30 patients
with pacemaker implanted due to vasovagal syncope in the Pacemaker Center,
Clinical Center of Serbia, between November 2003 and June 2014. Head-up tilt
test was performed to diagnose vasovagal syncope. Patients with
cardioinhibitory and mixed type of disease were enrolled in the study.
Results. Mean age was 48.1 ± 11.1 years and 18 (60%) patients were men. Mean
follow-up period was 5.9 ± 3.0 years. Primarily, implantable loop recorder
was implanted in 10 (33.3%) patients. Twenty (66.7%) patients presented
cardioinhibitory and 10 (33.3%) mixed type of vasovagal syncope. After
pacemaker implantation, 11 (36.7%) patients had syncope. In multiple logistic
regression analysis we showed that syncope is statistically more likely to
occur after pacemaker implantation in patients with mixed type of vasovagal
syncope (p = 0.018). There were two (6.7%) perioperative surgical
complications. Conclusion. Pacemaker therapy is a safe treatment for patients
with vasovagal syncope, whose efficacy can be improved by strict selection of
patients. We showed that symptoms occur statistically more often in patients
with mixed type of disease after pacemaker implantation.
Keywords: vasovagal syncope, pacemaker therapy, head-up tilt test