Treatment of malignant primary vasodepressive neurocardiogenic syncope with a rate responsive pacemaker driven by heart contractility

In a 41-year-old man suffering from frequent syncope, the tilt test reprodu cibly induced a primary vasodepressive neurocardiogenic syncope. Pharmacoth erapy either failed to prevent the syncope induced at the tilt test or was poorly tolerated. In the minutes preceding the syncope, a dramatic increase in heart contractility was sensed by microaccelerometer located at the tip of a right ventricular pacing electrode. When the tilt test was repeated w ith the pacemaker programmed in the DDDR mode, high rate dual ch amber paci ng occurred during the tilt phase and prevented the syncope. Three months a fter implantation, the patient remains totally symptom free.