Teenager with Vasovagal syncope

[CLH17]

My 17 year old son has vasovagal syncope.  He has fainted 4 times and was taken by ambulance to the hospital for these episodes.  The last episode resulted in a concussion and staples to the back of the head.He is a distance runner who is now not allowed to run, walk more than 1/2 mile, bike or do any other exercise.  His current meds are Proamatine 10mg twice daily and 5 mg once daily, Fludrocortisone .1mg once per day.  He drinks 64 ounces of Gatordae daily.  He is becoming very discouraged by the restrictions to doing any exercies.  He hopes to run track in three weeks, (distance events) and I know he will not be cleared for this.  Would a pacemaker help him resume his normal life?  Is there any chance he could be stabilized and able to run Crossy county in the fall, which will be his senior year of high school?  Is there anything else which could be done to help him at this time?

[CCF HeartMD-2]

Yes, we have a syncope clinic that he can schedule an appointment with.  Dr. Jaeger and Dr. Fouad are two specialists in this area in the Electrophysiology and Syncope Department

[CLH17]

Does Cleveland Clinic have a syncope specialist who would be able to assess him and give a second opinion?

[CCF HeartMD-2]

This is a very difficult question.  In general, we consider vasovagal syncope to be a benign condition which is typically responsive to conservative measures such as increasing salt intake and staying hydrated.  It appears that in your son's situation, these have not been benign, and has not gotten better with the midodrine and fludrocortisone. Vasovagal syncope is a problem of both heart rate and vasomotor tone.  The pacemaker does not help the vasomotor tone part, so even if pacemakers are implanted, often people with vasovagal syncope are not protected because only the heart rate problem is corrected.  Sometimes, SSRIs are used (Serotonin reuptake inhibitors) have been tried.  I would refer him to a syncope specialist for a second opinion.