To Pace or not to Pace for Neurally Mediated Syncope: Do We Know the Answer? A Positive View

Single chamber VVI mode pacing proved to be ineffective in vasovagal syncope treatment [1], while several nonrandomized studies [2–4] showed a significant decrease in recurrence in patients who underwent dual chamber pacing. In the last few years, three randomized, noncontrolled studies have shown the efficacy of dual-chamber pacemaker implantation in reducing recurrence in patients with recurrent neuromediated syncope. The VPS study [5] demonstrated the effectiveness of rate-drop response pacemakers in patients affected by neurally mediated syncope who gave a positive response in the tilting test, presenting a varying cardoinhibitory component. The VASIS study [6], on the other hand, showed the effectiveness of a DDI-mode pacemaker with hysteresis in patients with neurally mediated syncope and positive tilting test with a marked cardoinhibitory component. Finally, the SYDIT trial [7] reported the superiority of pacemaker implantation over drug treatment with s-blockers.