Pacemaker

[JC]

I am a very active, twenty-nine year old male who was diagnosed with NueroCardiogenic Syncope about two years ago.  I’ve had a Holter Monitor test that showed that my heartbeat dropped into the thirties at night while sleeping.  I’ve had a Tilt Test.  The results were abnormal, but nothing happened to me until I was injected with Isoprin.  Then I had the same dizzy, clammy feeling that I get quite often.  However, I have never actually blacked out from this.  My symptoms are a dizzy lightheaded feeling (usually numerous times a day),  fatigue (I almost feel hungover every day, and I rarely drink).  I also have episodes where I don’t feel like I have all of my balance and my vision seems slightly distorted.  I have been on Pindolol. Proametine, and a Florinef/Atenolol combination.  The Florinef/Atenolol combo seems to work a little, but I still have all of the symptoms (just not as intense).  I have also had three seizures in my life at the ages of 12, 18 and 19.  At the time of all three seizures, I was on Theodur for Asthma.  My EEG’s have always been normal and my doctor’s suggested that the high Theophyline  in the Theodur had probably caused the seizures.  At my primary care physician’s request, I made an appointment with a neurologist 6 months ago.  I had an EEG done, a MRI of the head and a glucose tolerance test.  Again, results were normal.  He then requested for a 24 hr EEG.  Again the results were normal.  However, it mentions that I had bradycardia through most of the test, dipping into the 30’s on occasion.  The neurologist said their was no reason to continue seeing me and referred me to another cardiologist.  

My new cardiologist asked me if I would be open to trying a temporary pacer for a few days in the hospital.  If everything went well, then we’d have it permanently inserted.  I’m all for this if it makes me feel better.  I’m all for it if there’s a chance of making me feel better!  I’m actually excited about this, but I don’t want to get my hopes up in case it doesn’t do the trick.  Before we take this step, he wants me to up my Atenolol dose from 50 mg a day to 100 mg.  He also wants me to continue with the Florinef.  After two weeks, if this is not working, he wants to try me on Zolof.  If that does not work, then we’ll proceed with the pacer.

My concern is that my cardiologist is not sure that this is actually Syncope.  Are there any other tests that can be done to determine what the problem is?  Would an echo help?  What about  a Stress Test?  Any suggestions would be greatly appreciated.  

p.s.  Sorry about the length of this post.        

[CCF CARDIO MD - DLB]

If you truly have neurocardiogenic syncope, a pacemaker is not unreasonable. It definitely helps some patients with neurocardiogenic syncope, those who have a low heart rate when they pass out. If you had a low heart rate when you started feeling bad during the tilt test (during the infusion of isoproterenol), the pacemaker might help. If not, it is unlikely to make you feel any better. You might consider an evaluation by a ear-nose-throat doctor to see if you have a problem with your balance. I assume you have worn the Holter monitor enough times that you heart rate was captured while you were having your typical symptoms.