Omar A R, Ng K-S, Ng W-L, Sutandar A
Cardiac Department, National University Hospital, Singapore.
Intern Med J. 2004 Aug;34(8):504-6. doi: 10.1111/j.1444-0903.2004.00626.x.
The indication for permanent pacemaker remains controversial in malignant neurocardiogenic syncope. A highly reproducible prolonged pause during a repeat head-up tilt-table testing may identify a subgroup of neurally mediated syncope with a prominent and consistent cardioinhibitory component. Seven patients (3 females) with a mean age of 30 years (23-44 years) were diagnosed to have malignant neurocardiogenic -syncope; all are classified according to the Vasovagal Syncope International Study as 2B type, with observed sinus pauses ranged from 3 s to 26 s of which only 1 demonstrated a reproducible sinus pause. No recurrence of syncope was clinically observed in patients during the follow-up period. Of 6 patients treated non--pharmacologically, one required a beta-blocker and none required a permanent pacemaker. Prolonged asystole manifest during head-up tilt-table testing is a poorly reproducible phenomenon and permanent pacemaker implantation in malignant neurocardiogenic syncope should not be a first line therapy.
永久性起搏器在恶性神经心源性晕厥中的应用指征仍存在争议。在重复的头高位倾斜试验中出现高度可重复的长间歇，可能识别出神经介导性晕厥的一个亚组，其具有显著且一致的心脏抑制成分。7例患者（3例女性），平均年龄30岁（23 - 44岁），被诊断为恶性神经心源性晕厥；所有患者根据国际血管迷走性晕厥研究均分类为2B型，观察到的窦性停搏时间为3秒至26秒，其中仅1例表现出可重复的窦性停搏。随访期间临床上未观察到患者晕厥复发。在6例接受非药物治疗的患者中，1例需要使用β受体阻滞剂，无人需要永久性起搏器。头高位倾斜试验中出现的长时间心脏停搏是一种难以重复的现象，恶性神经心源性晕厥患者植入永久性起搏器不应作为一线治疗方法。
