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. 2021 Jul 29;21(6):349–366. doi: 10.1016/j.ipej.2021.07.006
COR Recommendations
LOE References
Neurocardiogenic Syncope
IIa Permanent pacemaker implantation is reasonable with severe recurrent breath-holding spells with documentation of cardioinhibitory response on ECG monitoring and complicated by prolonged syncope, prolonged postanoxic convulsions, and other bradycardia-induced symptoms. B-NR [35,36]
IIb Permanent pacing may be considered for recurrent symptomatic neurocardiogenic syncope associated with documented spontaneous bradycardia or asystole in patients who have failed other medical treatments. C-LD [37,38]
IIb Permanent pacemaker implantation may be considered in patients with epilepsy associated with severe symptomatic bradycardia (ictal induced) who have failed to improve with antiepileptic medical therapy. C-LD [39]
IIINo benefit Permanent pacing is not indicated for neurocardiogenic syncope solely on the basis of a positive cardioinhibitory tilt response. C-EO
IIIHarm Permanent pacing is not indicated for neurocardiogenic syncope with hypotension as the major or significant component of the symptoms. C-EO