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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: [email protected]
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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.

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