Recurrent syncope of unknown origin: value of permanent pacemaker insertion

We studied the outcome of permanent pacing in those with a history suggestive of Stokes-Adams attacks but no electocardiographic evidence of bradyarryhthmia. Of 11 patients who fulfilled pre-defined inclusion criteria, over a mean follow-up period of 5.4 years, seven patients were free of symptoms and two were much improved following pacing. We suggest that in those with a clinical history of frequently recurrent Stokes-Adams attacks and a normal electrocardiogram, pacemaker insertion may be a reasonable course of action.