Maloney J D, Jaeger F J, Rizo-Patron C, Zhu D W
Baylor College of Medicine, Houston, TX 77030.
Am Heart J. 1994 Apr;127(4 Pt 2):1030-7. doi: 10.1016/0002-8703(94)90083-3.
The role of permanent cardiac pacing for the management of neurocardiogenic syncope is controversial; however, it does have a secondary role in appropriately selected individuals. Neurocardiogenic syncope includes vaso-vagal and enhanced antagonism of sympathetic-parasympathetic mechanisms. Differentiation of the so-called cardiac inhibitory, vasodepressor, and mixed forms of these disorders is frequently misleading when establishment of effective treatment strategies is attempted. Cardiac pacing can artificially restore near-normal heart rate and atrioventricular synchrony during a neurocardiogenic syncopal episode; however, cardiac pacing does not alter the peripheral vasodilatation, nor does it prevent the occurrence of the reflux response. Syncopal patients with carotid sinus hypersensitivity or vasovagal responses that include marked bradycardia and loss of atrioventricular synchrony can be supported by dual-chamber cardiac pacing in combination with other therapeutic interventions that diminish the severity of the reflex response. The conditions of patients with carotid sinus syndrome and carotid sinus hypersensitivity are frequently improved with cardiac pacing, and the conditions of elderly patients with vasovagal syncope are commonly improved with artificial pacing. The classic younger patient with malignant vasovagal syncope derives less benefit from artificial pacing; however, in carefully selected persons dual-chamber pacing combined with drug therapy and education decreases syncopal episodes and permits a return to normal activities.
永久性心脏起搏在神经心源性晕厥治疗中的作用存在争议；然而，在经过适当选择的个体中它确实具有次要作用。神经心源性晕厥包括血管迷走性以及交感 - 副交感神经机制的增强拮抗。在尝试制定有效治疗策略时，区分这些病症所谓的心脏抑制型、血管减压型和混合型往往会产生误导。心脏起搏可在神经心源性晕厥发作期间人为恢复接近正常的心率和房室同步性；然而，心脏起搏并不会改变外周血管扩张，也无法预防反流反应的发生。对于患有颈动脉窦过敏或血管迷走反应（包括明显心动过缓和房室同步性丧失）的晕厥患者，可通过双腔心脏起搏结合其他减轻反射反应严重程度的治疗干预措施来提供支持。心脏起搏常常能改善患有颈动脉窦综合征和颈动脉窦过敏患者的病情，人工起搏通常也能改善老年血管迷走性晕厥患者的病情。典型的年轻恶性血管迷走性晕厥患者从人工起搏中获益较少；然而，在经过精心挑选的患者中，双腔起搏联合药物治疗和教育可减少晕厥发作次数，并使患者能够恢复正常活动。
