TREATMENT OF MALIGNANT NEUROCARDIOGENIC VASOVAGAL SYNCOPE WITH A RATEDROP ALGORITHM IN DUAL-CHAMBER CARDIAC PACING

A 29-year-old man with malignant vasovagal syncope presented with epis odes of abrupt loss of consciousness associated with an aura, totaling more than 10 episodes over 3 months. Holter monitoring showed cardiac arrest with a duration of 15 seconds. Oral propranolol and disopyrami de therapy failed to prevent the syncope. A dual chamber pacemaker wit h a rate drop response algorithm successfully prevented the syncope bu t not the aura. There may be multifactors involved in the mechanism of this syndrome. The patient has returned to a normal active life. This rate drop algorithm is an effective therapy for the prevention of syn cope in malignant vasovagal syncope.