Neurocardiogenic (Vasodepressor) Syncope

Stefan Osswald, M.D., and Thomas G. Trouton, M.D.

N Engl J Med 1993; 329:30July 1, 1993

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Figure 1 Neurocardiogenic (Vasodepressor) Syncope.

A 72-year-old woman with breast cancer that had metastasized to the glossopharyngeal region had recurrent episodes of sudden lightheadedness, diaphoresis, and syncope. A dual-chamber pacemaker was implanted, but syncope recurred, always preceded by severe neck pain. During the tilt-table test with the pacemaker inactivated, the results of which are shown here, the patient's usual symptoms developed. She lost consciousness and had a seizure, but regained consciousness immediately after she was returned to the supine position. The study shows a profound vasodepressor reaction with minimal slowing of the sinus rhythm. Treatment with disopyramide (150 mg three times a day) eliminated the syncopal episodes over five months of follow-up.

Kim Eagle, M.D.

Stefan Osswald, M.D.
Thomas G. Trouton, M.D.
Massachusetts General Hospital, Boston, MA 02114

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