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Pacemaker use for the treatment of reflex-mediated syncope: 40-year experience at a single paediatric institution

Part of: Electrophysiology

Published online by Cambridge University Press:  28 October 2021

Thomas Huang ,
Edward O’Leary ,
Mark E. Alexander ,
Laura Bevilacqua ,
Francis Fynn-Thompson ,
Elizabeth S. DeWitt ,
Vassilios J. Bezzerides  and
Douglas Y. Mah Open the ORCID record for Douglas Y. Mah [Opens in a new window]
Thomas Huang
Affiliation:
Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
Edward O’Leary
Affiliation:
Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
Mark E. Alexander
Affiliation:
Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
Laura Bevilacqua
Affiliation:
Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
Francis Fynn-Thompson
Affiliation:
Department of Cardiovascular Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
Elizabeth S. DeWitt
Affiliation:
Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
Vassilios J. Bezzerides
Affiliation:
Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
Douglas Y. Mah*
Affiliation:
Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
*
Author for correspondence: D. Y. Mah, MD, Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USA. Tel: 617-355-7833; Fax: 617-730-0000. E-mail: douglas.mah@cardio.chboston.org
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Abstract

Introduction:

Reflex-mediated syncope occurs in 15% of children and young adults. In rare instances, pacemakers are required to treat syncopal episodes associated with transient sinus pauses or atrioventricular block. This study describes a single centre experience in the use of permanent pacemakers to treat syncope in children and young adults.

Materials and methods:

Patients with significant pre-syncope or syncope and pacemaker implantation from 1978 to 2018 were reviewed. Data collected included the age of presentation, method of diagnosis, underlying rhythm disturbance, age at implant, type of pacemaker implanted, procedural complications and subsequent symptoms.

Results:

Fifty patients were identified. Median age at time of the first syncopal episode was 10.2 (range 0.3–20.4) years, with a median implant age of 14.9 (0.9–34.3) years. Significant sinus bradycardia/pauses were the predominant reason for pacemaker implant (54%), followed by high-grade atrioventricular block (30%). Four (8%) patients had both sinus pauses and atrioventricular block documented. The majority of patients had dual-chamber pacemakers implanted (58%), followed by ventricular pacemakers (38%). Median follow-up was 6.7 (0.4–33.0) years. Post-implant, 4 (8%) patients continued to have syncope, 7 (14%) had complete resolution of their symptoms, and the remaining reported a decrease in their pre-syncopal episodes and no further syncope. Twelve (24%) patients had complications, including two infections and eight lead malfunctions.

Conclusions:

Paediatric patients with reflex-mediated syncope can be treated with pacing. Complication rates are high (24%); as such, permanent pacemakers should be reserved only for those in whom asystole from sinus pauses or atrioventricular block has been well documented.

Keywords

Paediatricsyncopepacemaker
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 9 , September 2022 , pp. 1440 - 1445
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Joint first authorship – Mr. Huang and Dr. O’Leary contributed equally to this paper.

References

Lewis, DA, Dhala, A. Syncope in the pediatric patient. The cardiologist’s perspective. Pediatr Clin North Am 1999; 46: 205–219.CrossRefGoogle ScholarPubMed
Friedman, KG, Alexander, ME. Chest pain and syncope in children: a practical approach to the diagnosis of cardiac disease. J Pediatr 2013; 163: 896–901.CrossRefGoogle Scholar
Brignole, M, Deharo, JC, Menozzi, C, et al. The benefit of pacemaker therapy in patients with neurally mediated syncope and documented asystole: a meta-analysis of implantable loop recorder studies. Europace 2018; 20: 1362–1366.CrossRefGoogle ScholarPubMed
Brignole, M, Menozzi, C, Moya, A, et al. Pacemaker therapy in patients with neurally mediated syncope and documented asystole: Third International Study on Syncope of Uncertain Etiology (ISSUE-3): a randomized trial. Circulation 2012; 125: 2566–2571.CrossRefGoogle Scholar
Varosy, PD, Chen, LY, Miller, AL, Noseworthy, PA, Slotwiner, DJ, Thiruganasambandamoorthy, V, et al. Pacing as a treatment for reflex-mediated (vasovagal, situational, or carotid sinus hypersensitivity) syncope: a systematic review for the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2017; 14: e255–e269.CrossRefGoogle Scholar
Kelly, AM, Porter, CJ, McGoon, MD, Espinosa, RE, Osborn, MJ, Hayes, DL. Breath-holding spells associated with significant bradycardia: successful treatment with permanent pacemaker implantation. Pediatrics 2001; 108: 698–702.CrossRefGoogle ScholarPubMed
Legge, LM, Kantoch, MJ, Seshia, SS, Soni, R. A pacemaker for asystole in breath-holding spells. Paediatr Child Health 2002; 7: 251–254.CrossRefGoogle ScholarPubMed
Di Pino, A, Calabro, MP, Gitto, P, Bianca, I, Oreto, G. Permanent cardiac pacing for severe pallid breath-holding spells. Pacing Clin Electrophysiol 2007; 30: 280–282.CrossRefGoogle ScholarPubMed
Varosy, PD, Chen, LY, Miller, AL, Noseworthy, PA, Slotwiner, DJ, Thiruganasambandamoorthy, V. Pacing as a treatment for reflex-mediated (vasovagal, situational, or carotid sinus hypersensitivity) syncope: a systematic review for the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2017; 136: e123–e135.CrossRefGoogle Scholar
Carano, N, Bo, I, Zanetti, E, Tchana, B, Barbato, G, Agnetti, A. Glycopyrrolate and theophylline for the treatment of severe pallid breath-holding spells. Pediatrics 2013; 131: e1280–1283.CrossRefGoogle ScholarPubMed
Vyas, A, Swaminathan, PD, Zimmerman, MB, Olshansky, B. Are treatments for vasovagal syncope effective? A meta-analysis. Int J Cardiol 2013; 167: 1906–1911.CrossRefGoogle ScholarPubMed
Lukkarinen, H, Virtanen, I, Arikka, H, Arola, A, Peltola, M, Ekblad, H. Recurrent sinus arrest and asystole due to breath-holding spell in a toddler; recovery with levetiracetam-therapy. Circulation 2010; 122: e637.CrossRefGoogle Scholar
Walsh, M, Knilans, TK, Anderson, JB, Czosek, RJ. Successful treatment of pallid breath-holding spells with fluoxetine. Pediatrics 2012; 130: e685–689.CrossRefGoogle ScholarPubMed
Izcovich, A, Gonzalez Malla, C, Manzotti, M, Catalano, HN, Guyatt, G. Midodrine for orthostatic hypotension and recurrent reflex syncope: a systematic review. Neurology 2014; 83: 1170–1177.CrossRefGoogle ScholarPubMed
Morillo, CA, Leitch, JW, Yee, R, Klein, GJ. A placebo-controlled trial of intravenous and oral disopyramide for prevention of neurally mediated syncope induced by head-up tilt. J Am Coll Cardiol 1993; 22: 1843–1848.CrossRefGoogle ScholarPubMed
Salim, MA, Di Sessa, TG. Effectiveness of fludrocortisone and salt in preventing syncope recurrence in children: a double-blind, placebo-controlled, randomized trial. J Am Coll Cardiol 2005; 45: 484–488.CrossRefGoogle ScholarPubMed
Sheldon, R, Raj, SR, Rose, MS, et al. Fludrocortisone for the prevention of vasovagal syncope: a randomized, placebo-controlled trial. J Am Coll Cardiol 2016; 68: 1–9.CrossRefGoogle ScholarPubMed
Sartori, S, Nosadini, M, Leoni, L, et al. Pacemaker in complicated and refractory breath-holding spells: when to think about it? Brain Dev 2015; 37: 2–12.CrossRefGoogle Scholar
Fortescue, EB, Berul, CI, Cecchin, F, Walsh, EP, Triedman, JK, Alexander, ME. Patient, procedural, and hardware factors associated with pacemaker lead failures in pediatrics and congenital heart disease. Heart Rhythm 2004; 1: 150–159.CrossRefGoogle Scholar
Takeuchi, D, Tomizawa, Y. Pacing device therapy in infants and children: a review. J Artif Organs 2013; 16: 23–33.CrossRefGoogle ScholarPubMed
Lamas, GA, Lee, KL, Sweeney, MO, et al. Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. N Engl J Med 2002; 346: 1854–1862.CrossRefGoogle ScholarPubMed
Stone, JM, Bhakta, RD, Lutgen, J. Dual chamber sequential pacing management of sinus node dysfunction: advantages over single-chamber pacing. Am Heart J 1982; 104: 1319–1327.CrossRefGoogle ScholarPubMed