Permanent cardiac pacing is a promising option for patients with severe vasovagal syncope. Syncope and presyncope are probably the most common cardiovascular symptoms, and the vasovagal reaction is likely to be the cause of most of these symptoms. Although most patients are troubled infrequently, there is a sizable minority with frequent and highly distressing symptoms. Despite progress and recommendations by expert consensus panels about the indications for pacing for vasovagal syncope,<sup>8 Clarke M., Sutton R., Ward D. , e al. Recommendations for pacemaker prescriptions for symptomatic bradycardia. British Pacing and Electrophysiology Group Working Party Report Br Heart J 1991 ;  66 : 185-191

Cliccare qui per andare alla sezione Riferimenti, 13 Dreifus L.S., Fisch C., Griffin J.C. , e al. Guidelines for implantation of cardiac pacemakers and antiarrhythmia devices: A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Procedures (Committee on Pacemaker Implantation) J Am Coll Cardiol 1991 ;  18 : 1-13

Cliccare qui per andare alla sezione Riferimenti</sup> there are numerous concerns about the appropriateness and usefulness of permanent pacing and about patient and pacemaker selection. Are patients sufficiently symptomatic to warrant such an invasive and expensive approach? Is pacing useful in a syndrome that may be characterized as much by vasodepression as by bradycardia? Why not concentrate on pharmacologic strategies? If pacing is used, what detection and treatment modes should be used? This article reviews evidence that addresses each of these questions.