Comparison of Cardiac Pacing with Conservative Approach in the Treatment of Cardioinhibitory Vasovagal Syncope Identified, the National Heart Centre Singapore Experience

Abstract

Objectives: To evaluate the effects of cardiac pacing compared to medical therapy in cardioinhibitory syncope patients in National Heart Centre Singapore (NHCS). Methods: All tilt table tests conducted at NHCS from Jan-2004 to Dec-2008 were retrospectively reviewed to identify cardioinhibitory syncope patients with assystole of at least 3 seconds. Demographic data, frequency of symptoms and management were recorded. Data was reported as percentages (categorical) and mean (continuous). Treatments were compared using student T Test (continuous variables) and Fisher Exact Test (categorical). Results: 761 tilt tests were conducted. 348 tests were positive, for which 33 patients had cardioinhibitory response. Mean patient age was 40.9 years and 64% were male. Permanent pacemaker was offered to 11 patients at the physicians discretion. 9 patients received pacemaker. 24 patients were managed conservatively. Pacemaker group was older (56.2 year vs 35.2 years) and had longer asystole on tilt test (17.7 seconds vs 10 seconds). Mean follow-up duration was 35 months. There was no mortality. Regardless of treatment approach, 88% of patients experienced symptom improvement and 64% remained syncope-free. There was no significant difference in frequency and recurrence of symptoms between the 2 groups. Conclusions: In cardioinhibitory syncope patients diagnosed on tilt table test, pacemaker implantation did not seem to provide better outcome in preventing and improving syncope compared to conservative treatment alone.