Conclusion
In conclusion, syncope in a pacemaker patient is a serious symptom requiring action. It is quite rare for its explanation to be pacemaker hardware malfunction (around 5 % of cases) and it is much more commonly due to reflex syncope involving vasodepression, which may be iatrogenic by excessive hypotensive therapy. Syncope in pacemaker patients is not as rare as often thought, occurring in 18 % of sinus node disease patients in 10 years and 55 % of tilt positive vasovagal patients in 2 years.