Malignant Vasovagal Syncope

[Sangee]

I have a diagnosis of Malignant Vasovagal Syncope, strongly mixed type with convulsion and asystole of 38 seconds with nitroglycerine challenge; I had IV atropine and recovered once returned supine.  Another test was done pretreated with oral atropine and again challenged with nitroglycerine.  Here is till had asystole and convulsion over 10 seconds; another IV Atropine recovery.  Next, while still under the effects of IV Atropine, I was again challenged with nitroglycerine and maintained heart rate at 90 bpm, but lost detectable blood pressure, once it came back It read 40/28.

So, my Cardiologist isn't leaning toward or away from one of two treatment routes because I'm mixed type.  A pacemaker with Midodrine or IV Aropine in medically triggering situations and Midodrine.  He states that the data on outcomes doesn't indicate one over the other, but that a pacemaker might be more helpful in an "emergency" situation.  He also offered to retilt to test out my question about my Epipen as a possible emergency measure.

However, one nurse told me that Atropine will not start a stopped heart, that it is for a slowed heart (how did it help me when I flat lined then?). She stated that the cardiologist she works with puts in pacemakers for paused over 4 seconds. My sister-in-law, a pharmasist, favors the medication route, pointing to the possible complications of pacemaker implant and the normally benign course of VVS (I should have told you my reason for first seeking care was CPR and bagging triggered during a minimally invasive medical procedure).  My mother, a director of a school of radiologic technology, favors the pacemaker.  One other cardiologist said that he had a patient like me who didn't get a pacemaker who died.  My husband is also in favor of medications so that I can keep my hobbies of gardening and backpacking, as well as being able to lift the weight required by my work.

So, I have read the research too.  My reading gives me the same impression that my cardiologist has presented.  Who really knows, there is not clear research for treatment options.  

So here, I can ask the medical community.  What is the current thinking on the type of problem.  I have REALLY DIFFICULT recovery after syncope, and it even bursts the blood vessels in my eyes.  I feel ill for weeks after it is over.  The Atropine really helped with that - and I do mean significantly, but it wasn't perfect.  

My reservations about the pacemaker are scar tissue, I'm young and could need several replacements, lead fractures, ending up with multiple leads, loss of access to some medical testing and some medical treatments and the impact on lifting things for life.

I really need advice and my cardiologist is on the fence.

[Sangee]

Thank you for your thoughts about pacemakers.  My type of problem is a bit different from what your daughter faced.  Your daughter faced something much more serious than I have to face.  

[grendslori]

My daughter had a duel chamber pacemaker for years without any difficulty from that pacemaker at all and she had very severe heart disease that eventually ended with a transplant. She was having presyncope and syncope and went into shock the one time the doctors had the gutds to do the tiltr test on her. With a pacemaker you may have a two inch scar from the insert, but so what??? Are you more concerned about a scar at your age or dying? The only thing that was a medical test that I know of that can't be done is an MRI. You can still have x-rays and a CAT Scans. Lead fractures happen if a person has a hard direct blow to the chest....the leads may or may not break. The implant is simple, done in a cath lab, many times as an outpatient and the batteries give warnings of a few months before they need to be replaced and you may need to replace the battery every 10 years. There isn't such a thing as multiple leads, there are one or two, one for the atrium, one for the ventricle and thats only if you need a duel chamber pacemaker. Get the pacemaker and go on with your life!