@Article{chd.12682,
AUTHOR = {Christian Paech, Franziska Wagner, Sebastian Mensch, Roman Antonin Gebauer},
TITLE = {Cardiac pacing in cardioinhibitory syncope in children},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {13},
YEAR = {2018},
NUMBER = {6},
PAGES = {1064--1068},
URL = {http://www.techscience.com/schd/v13n6/39090},
ISSN = {3071-1738},
ABSTRACT = {<b>Introduction:</b> Reflex vasovagal—or cardioinhibitory syncope is known to be a major 
cause of recurrent syncope in children. The mechanism of vasovagal syncope (VVS) is 
an interaction between a vagally mediated bradycardia or asystole and a more or less 
manifest vasodilatory component. Although pacing is not advisable as a standard 
approach in patients with VVS, it remains a treatment option of last resort in excep‐
tionally severe cases, or patients with contraindication or refractoriness to drug ther‐
apy and life style changes. To effectively avoid VVS in these patients, the pacemaker 
has to both prevent bradycardia and to compensate for the vasodilatory component. 
Therefore, this study aimed to evaluate a simple pacemaker setting (VVI pacing with 
hysteresis) with the potential to prevent VVS in affected children.<br/>
<b>Methods:</b> Clinical data of patients, who were presented to the Department for 
Pediatric Cardiology, Heart Center Leipzig, in the period of 2001‐2017 for cardiac 
pacemaker implantation for cardioinhibitory syncope or pallid breath‐holding spells, 
were collected retrospectively.<br/>
<b>Results:</b> Eleven pediatric patients, median age 2.7 (0.8‐17) years, were included. 
Pacemaker settings are depicted. In 10 out of 11 patients, an entire abolishment of 
syncope could be achieved (P = .002).<br/>
<b>Conclusion:</b> The presented VVI pacing with hysteresis seems to be a promising pace‐
maker setting in pediatric patients with cardioinhibitory syncope who need a pace‐
maker. Unnecessary ventricular stimulation is effectively avoided, while cardiac output 
is preserved during cardioinhibition, by providing a sufficient paced heart rate, com‐
pensating for the often present vasodilatory component.},
DOI = {10.1111/chd.12682}
}