Pacemaker Benefit in a Patient with Vasovagal Syncope with Asystole

A 49-year-old woman has had several episodes of syncope with pallor and diaphoresis since she was 13 years old. She had been diagnosed with rheumatic heart disease and was submitted to mitral and aortic valve replacement for mechanical prosthesis. She was submitted to a tilt table test with presyncope at the 2nd min, progressing to loss of consciousness and bradyarrhythmia followed by asystole. Due to persistent, asystole atropine was administered unsuccessfully. She underwent cardiac massage with recovery to sinus rhythm after 61.5 seconds, without sequelae. After about 2 h, when blood was collected for examination, she presented a new episode of consciousness loss with asystole and prompt response to heart massage. She was submitted to the implant of a dual chamber pacemaker. After a 36-month follow-up, she has not had any new episode of syncope.