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Cardiac pacing for severe childhood neurally mediated syncope with reflex anoxic seizures
Open accessAbstract
OBJECTIVE: To determine whether permanent cardiac pacing could prevent syncope and seizures in children with frequent severe neurally mediated syncope, and if so whether dual chamber pacing was superior to single chamber ventricular pacing. METHODS: Dual chamber pacemakers were implanted into 12 children (eight male, four female) aged 2-14 years (median 2.8 years) with frequent episodes of reflex anoxic seizures and a recorded prolonged asystole during an attack. The pacemaker was programmed to sensing only (ODO), single chamber ventricular pacing with hysteresis (VVI), and dual chamber pacing with rate drop response (DDD) for four month periods, with each patient allocated to one of the six possible sequences of these modes, according to chronological order of pacemaker implantation. The parent and patient were blinded to the pacemaker mode and asked to record all episodes of syncope or presyncope ("near miss" events). The doctor analysing the results was blinded to the patient and pacemaker mode. RESULTS: One patient was withdrawn from the study after the pacemaker was removed because of infection. In the remaining children, both dual chamber and single chamber pacing significantly reduced the number of syncopal episodes compared with sensing only (p = 0.0078 for both). VVI was as effective as DDD for preventing syncope, but DDD was superior to VVI in reducing near miss events (p = 0.016). CONCLUSIONS: Permanent pacing is an effective treatment for children with severe neurally mediated syncope and reflex anoxic seizures. VVI is as effective as DDD in preventing syncope and seizures, but DDD is superior in preventing overall symptoms.
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“These patients were refractory to multiple medications and appeared to benefit from cardiac pacing.”
From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [142]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“A small, single-blind randomized trial reported that permanent cardiac pacing greatly reduced syncope burden in young children, with frequent syncope associated with documented asystole.142”
From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [142]
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“Finally, a small, double-blind study reported that pacing improved symptoms in very young patients with frequent vasovagal syncope.142”
From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [142]
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“even in the presence of VVS with prolonged asystole, pacemakers should be avoided due to the relatively transient and benign nature of the syndrome.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [402]
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Head up tilt試験を用いた神経調節性失神(Neurally mediated syncope:NMS)の病型診断と治療戦略の検討
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Pacing in Vasovagal Syncope: Are Too Many or Too Few Pacemarkers Implanted
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Herzschrittmacherimplantation bei blassen Affektkrämpfen
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Reflex anoxic seizure: an important diagnosis to remember
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Metadata
- Authors
- McLeod, K. A., Wilson, N., Hewitt, J., Norrie, J., & Stephenson, J. B. P.
- Affiliations
- Royal Hospital for Children (GB)
- Corresponding author
- McLeod, K A
- Venue
- Heart
- Publisher
- BMJ
- Published
- 1999-12-01
- Volume
- 82
- Issue
- 6
- Pages
- 721-725
- ISSN
- 1355-6037 (ISSN-L)
- PMC
- PMC1729207
- OpenAlex
- W2058222956
- Semantic Scholar
- 0ad55906e4a56954e5cb386739cc68c64512764c
- Cited by
- 102
- References
- 26
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 1 · 2021: 5 · 2018: 9 · 2017: 8 · 2016: 6 · 2015: 3 · 2014: 2 · 2013: 6 · 2012: 4
- FWCI
- 4.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Heart (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- neurally mediated syncope, cardiac pacing, DDD pacing, single-chamber ventricular pacing, syncope prevention, near misses, children
- MeSH terms
- Adolescent, Cardiac Pacing, Artificial, Hypoxia, Brain, Child, Child, Preschool, Double-Blind Method, Electrocardiography, Female, Humans, Male, Seizures, Syncope, Vasovagal
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