My 19 y.o. son has had 10 syncope episodes since he was little, usually triggered by pain plus stress. I can see he doesn't breath and has no pulse. We changed doctors several times because they didn't believe me. Finally he got a diagnosis of benign neurocardiogenic syncope but still no belief on the pauses.
Recently we saw a new doctor who asked for a tilt-table test which came out positive with a 36 seconds pause, dx "neurocardiogenic syncope, cardioinhibitory". This doctor said he has malignant syncope and he's in danger of sudden death and needs a pacemaker. Other labs are: echo (normal), holter (normal with sinus bradi at 40, sinus tachi at 175, one SVES), and hi-res ECG with hi R-R variability. I took him to another opinion with a syncope specialist who says it's benign syncope and no need for pacemaker and recommended getting fit, maintaining hydration, tilt-training etc. Last week he took a ergoespirometric test and had right bundle block pre-exercise (inhale-exhale-hyperventilation phase) but was otherwise a normal test with good recommendation for exercising; fitness zone 130-145. Sometimes he wakes up with numbness in the arms which we couldn't correlate to anything and he is otherwise a bright young man.
Is this benign syncope, malignant syncope, or some other neurology/cardiology condition? Does he need a pacemaker? Is he in risk of sudden death? What else to do, where else to go? Thanks.