Pacemaker effectiveness for syncope

After dealing with vasovagal syncope (randomly passing out, on average about once a year) for 27+ years (with increasingly longer recovery time), my cardiologist recommended a pacemaker.

Has anyone else dealt with this issue?

And has the pacemaker helped to prevent a syncope episode?

I'm 56, in good shape, active and run a few times per week. My heart and rhythms seem fine, but when I run into a vasovagal syncopal episode, my BP and heart rate drop.  So, I'm hoping that the pacemaker will help.

Any related thoughts or insight is appreciated --Chris

3 Comments

Defer to Cardiologist's Advice

by Penguin - 2023-06-15 18:19:01

Hi Chris, 

I see from your bio that you already have a Biotronik device implanted for syncope. 

Vasovagal episodes are a tricky area as falling BP is the underlying issue and pacemakers can't really do anything about falling BP. They increase h/rate - but this doesn't necessarily help.  This means that usually pacemakers have to be used in conjunction with other treatments - vasovagal manoevres, support stockings, medication and knowing your triggers and avoiding them.  

This article describes some of the tests which preceed pacemaker implantation which you may have had. https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/ask-the-experts/pacemakers-and-fainting#:~:text=A%20pacemaker%20is%20only%20used,faint%20that%20it%20stops%20completely.

Pacemakers can have a 'rate drop' algorithm which will detect when your heart rate begins to fall prior to a syncopal episode and which will try to 'pick up your heart rate' before you actually faint.  It would also be helpful to discuss how you can deal with BP drops with your cardiologist which you say, occur (on average) once a year.  Most medication is taken regularly to build higher BP and some meds have significant side effects if not taken regularly.  I don't know how I'd feel about taking those drugs (Midrodine, Fludrocortisone, Prozac are some suggested) reguarly for infrequent faints. They're quite a big commitment if you faint once a year! 

It may be helpful to know your triggers - common ones include strong emotions, heat, defecation, swallowing.  It's obviously difficult to avoid some of these (!! ) and being prepared can be difficult depending upon how much warning you have before you faint. However, recognising your triggers and typical symptoms pre-fainting can be helpful if you get some warning.  

Vasovagal swallow syncope sufferer here

by Gemita - 2023-06-15 21:08:16

Chris, Penguin has already given good information.

I am a syncope sufferer, or was in the years leading up to my pacemaker.  I have intermittent vasovagal "swallow syncope" due to high pressure oesophageal contractions (a motility disorder) and these are also a common trigger for my fast atrial arrhythmias.  I have lost consciousness while eating on several occasions in the past.  

Although my motility disorder frequently still occurs, with medication for my arrhythmias, treatment for my motility disorder, together with my pacemaker steadily beating and keeping my heart rate up, I rarely faint these days.  At worst, I only experience “pre-syncope” which is manageable and never leads to a loss of consciousness anymore.

As Penguin says, vasovagal syncope may be difficult to manage because it is caused by both a fall in heart rate and a fall in blood pressure.  The pacemaker can effectively treat a fall in heart rate but not a fall in blood pressure.  However, I find that by maintaining a steady, higher heart rate, this takes the edge off my symptoms when they occur and prevents a loss of consciousness.  

I really don’t think a responsible doctor would recommend a pacemaker if he/she hadn't seen good reason to believe that you could be helped by having a pacemaker implanted.  Since you appear to already have a pacemaker, you will have to wait and see whether it will help with an infrequent syncope event?  I find keeping well hydrated at all times helps keep my blood pressure up, so that if I do have a sudden dip, I am less likely to faint.  So hydration, hydration and more hydration is the key to success.

I hope you have as much success with your pacemaker as I have had.  I send my very best wishes for a good outcome.

Will pacemaker help VVS?

by Gotrhythm - 2023-06-16 13:48:17

As I read your post, it looks like that's your fundamental question.

The answer isn't a simple yes or no. The what causes what in vasovagal syncope is so full of twists that it's hard for us non-medical people to follow.

In one of those twists life can throw at us, my VVS was discovered after I already had a pacemaker. If that's not proof a pacemaker won't prevent a syncopal episode, I don't know what is.

On the other hand, a pacemaker will prevent your heart rate from falling to zero which could happen during a VVS episode. It happened to a friend of mine 8 or 9 years ago. Like you she now has a perfectly healthy heart and a pacemaker. PS she has never fainted again. Has the pacemaker "prevented" unconsciousness? Maybe. Who knows?

In cases of VVS, I think of my pacemaker as like a parachute. A parachute won't prevent a plane crash. If a crash is imminent, however, having a parachute gives you an option other than going down with the plane.

Added later: I just read over my post. Cannot believe how many typos even though I DID proofread it. Heart acting up. Brain off line. Apologies.

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