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Thread: Vasovagal Syncope and avoiding a pacemaker

  1. #11
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    Quote Originally Posted by jfsully View Post
    Yes, this should definitely be worked up and characterized before putting in a device, but I would just add that dying from the syncope itself is not the only concern. Regardless of the cause, sudden loss of consciousness can be a big problem if you are driving, swimming, holding a baby, rock climbing, etc. Not to mention it's a bummer to have an ambulance called on you unnecessarily every time you drop in the grocery store or mall. Fainting 2/week puts a huge crimp in your lifestyle. So even if it's "benign," it needs treatment. Whether a pacer is needed is another story. Pacers are pretty darn expensive, so I would assume that at the very least the insurance company is insisting on proper eval and perhaps trial of other treatment first, even if the doctor is a pacer-happy cowboy who drives a Bentley with a "MEDTRONIC" vanity plate. But maybe I shouldn't assume these things...
    This. Also, if it were me I'd consult with an electrophysiologist. Not my wheelhouse, but I'd want to know if there was a prospect for ablative therapy before somebody put a fucking Gameboy in my chest.

  2. #12
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    Oh, sure. Iím already operating under the assumption that the syncope itself isnít going to off her. Iím just saying, if this is as advertised, then pacer is the logical choice

  3. #13
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    I think she needs to gain about 20 pounds of bodyweight. She's not very "robust," and it usually helps with frailty.

  4. #14
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    Quote Originally Posted by Jonathon Sullivan View Post
    This. Also, if it were me I'd consult with an electrophysiologist. Not my wheelhouse, but I'd want to know if there was a prospect for ablative therapy before somebody put a fucking Gameboy in my chest.


    Canít ablate something that isnít there. Bradyasystole isnít an arrhythmogenic focus or an accessory pathway.

  5. #15
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    Agreed, but I haven't seen a rhythm strip or EKG on this lady yet. I'm not sure I accept the diagnosis.

    ĎAblation before Pacemakerí in a patient with bradycardia: a case report | QJM: An International Journal of Medicine | Oxford Academic

  6. #16
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    I would be fairly sure if sheís under a cardiologist theyíve looked for a potentially treatable cause- how far they go down a full electrophysiological study is down to them. But in the absence of a reversible cause for the bradycardias a PPM could be the best treatment and is a VERY low risk procedure for someone who sounds young with no co morbidities. My point is that it is by no means a ludicrous option, but should not be undertaken lightly.

    Just as an anecdote, my sister was troubled with wolff-Parkinson-white picked up after pregnancy and was getting semi regular tachycardias and had an ablation planned. She started to lose weight before the procedure and utilised some weight training as part of it. The tachycardias disappeared and Iíve always wondered if frequent valsalva manouveres during lifting could have contributed to the problem resolving.

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