Sheldon R
Cardiovascular Research Group, University of Calgary, Alberta, Canada.
Am J Cardiol. 1999 Oct 21;84(8A):26Q-32Q. doi: 10.1016/s0002-9149(99)00627-x.
Patients with frequent vasovagal syncope have a markedly poor quality of life and are often resistant to treatment by standard pharmacologic approaches. Although the evidence is not conclusive, clinical vasovagal syncope is probably associated with some degree of bradycardia. Studies of temporary pacing during tilt-table testing have shown that pacing prevents syncope in more than half of patients who develop a vasovagal response. Three open-label studies of permanent pacing showed that pacing was associated with substantial improvement, and the prospective randomized Vasovagal Pacemaker Study reported an 85% relative risk reduction in patients randomized to pacemaker therapy compared with medical therapy. The roles of specific pacemaker modes in vasovagal syncope have not been determined, although early evidence indicates that rate-drop responsiveness is useful. The second Vasovagal Pacemaker Study may clarify the role of rate-drop responsiveness.
频繁发生血管迷走性晕厥的患者生活质量明显较差，且通常对标准药物治疗方法耐药。尽管证据尚无定论，但临床血管迷走性晕厥可能与一定程度的心动过缓有关。倾斜试验期间临时起搏的研究表明，起搏可预防超过半数出现血管迷走反应的患者发生晕厥。三项关于永久起搏的开放标签研究表明，起搏可带来显著改善，前瞻性随机血管迷走性起搏器研究报告称，与药物治疗相比，随机接受起搏器治疗的患者相对风险降低了85%。尽管早期证据表明心率下降反应性有用，但特定起搏器模式在血管迷走性晕厥中的作用尚未确定。第二项血管迷走性起搏器研究可能会阐明心率下降反应性的作用。
