Browse the corpus

©2013 UpToDate ® Print Email ACC/AHA/HRS guideline summary: Permanent pacing in hypersensitive carotid sinus syndrome and neurocardiogenic syncope Class I - There is evidence and/or general agreement that permanent pacing is indicated in patients with hypersensitive carotid sinus syndrome or neurocardiogenic syncope in the following setting: • Recurrent syncope caused by spontaneously occurring carotid sinus stimulation and carotid sinus pressure that induces ventricular asystole of more than 3 seconds. (Level of Evidence: C) Class IIa - The weight of evidence or opinion is in favor of the usefulness of permanent pacing in patients with hypersensitive carotid sinus syndrome or neurocardiogenic syncope in the following setting: • Syncope without clear, provocative events and with a hypersensitive cardioinhibitory response of 3 seconds or longer. (Level of Evidence: C) Class IIb - The evidence or opinion is less well established that permanent pacing in hypersensitive carotid sinus syndrome and neurocardiogenic syncope are beneficial in the following setting: • Significantly symptomatic neurocardiogenic syncope associated with bradycardia documented spontaneously or at the time of tilt-table testing. (Level of Evidence: B) Class III - There is evidence and/or general agreement that permanent pacing is not indicated in patients with hypersensitive carotid sinus syndrome or neurocardiogenic syncope in the following settings: • A hypersensitive cardioinhibitory response to carotid sinus stimulation without symptoms or with vague symptoms. (Level of Evidence: C) • Situational vasovagal syncope in which avoidance behavior is effective and preferred. (Level of Evidence: C) Adapted from Epstein, AE, DiMarco, JP, Ellenbogen, KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350.