Recommendations—Pacemakers for Syncope

	Class	Level
Dual-chamber pacing can be effective for patients 40 years of age or older with recurrent and unpredictable syncope who have a documented pause ≥3 seconds during clinical syncope or an asymptomatic pause ≥6 seconds.	IIa	B-R
Tilt-table testing may be considered to identify patients with a hypotensive response who would be less likely to respond to permanent cardiac pacing.	IIb	B-NR
Pacing may be considered for pediatric patients with recurrent syncope with documented symptomatic asystole who are refractory to medical therapy.	IIb	B-R
Dual-chamber pacing may be considered in adenosine-susceptible older patients who have unexplained syncope without a prodrome, a normal ECG, and no structural heart disease.	IIb	C