Neurocardiogenic Syncope

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Abstract
As is often the case, many therapies in medicine are prescribed on the basis of assumptions or logical deductions but without data to support their use. For example, in neurocardiogenic syncope, in which hypotension is associated with paradoxical bradycardia, heart block, or sinus arrest, one could argue that implantation of a pacemaker to prevent the bradycardia is a rational treatment1. In this issue of the Journal, Sra et al.2 say that it is not effective. In their study they maintained the heart rate at a level 20 percent above the resting level by means of cardiac pacing but did . . .