Aim: To assess the efficacy of cardiac pacing in a selected group of patients with severe clinical presentation of certain or suspected neurally-mediated reflex syncope (NMS), age > 40 years and evidence of a cardio-inhibitory activity (CI) documented by Implantable Loop Recorder (ILR).
Methods: We selected, using the ILR, patients with a CI mechanism and treated them implanting a dual chamber PM with rate drop response (RDR) algorithm. Other patients were sent to “training” sessions of learning the Isometric Counterpressure Maneuvers (ICPM).
Results: We analysed 71 patients (period 2007-2012). 21 patients received a PM (mean age 68+13 years). After an average follow-up period of 23+12 months, among the treated patients recurrences occurred in 5 patients (24%). 16 patients (76%) had no recurrences.
There was an improvement of the quality of life in all treated patients.
Conclusions: PM implantation is justified only in well selected patients. Dual chamber PM with RDR algorithm is efficient for preventing recurrences and improve the quality of life. In some cases it could be necessary to perform a “hybrid” therapy (PM + ICPM).