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Brain, Vol. 109, No. 2, 345-356, 1986
© 1986 Oxford University Press

research-article

ATRIAL DEMAND PACING TO PROTECT AGAINST VAGAL OVERACTIVITY IN SYMPATHETIC AUTONOMIC NEUROPATHY

R. BANNISTER, D. F. DA COSTA, W. G. HENDRY, J. JACOBS* and C. J. MATHIAS

Departments of Neurology and Medicine, St Mary's Hospital and Medical School Praed Street, London W2 *Department of Neuropathology, Institute of Neurology, The National Hospital Queen Square, London WC1

Correspondence to: Correspondence to Sir Roger Bannister, Department of Neurology, St Mary's Hospital, Praed Street, London W2 INY

The clinical features, investigation and management of a patient with a subacute autonomic neuropathy are described. A series of physiological and biochemical studies indicated severe but selective sympathetic cardiovascular dysfunction, associated with bradycardia. The bradycardia was enhanced by raising blood pressure but there was no other evidence either of cardiac vagal impairment or hyperreactivity. Oral atropine prevented the bradycardia but had to be withdrawn because of intolerable side effects An atrial demand pacemaker was implanted to elevate basal heart rate and prevent bradycardia. The pacemaker alone did not improve postural hypotension but it enabled the blood pressure to be readily and safely controlled by a combination of drugs

Received April 11, 1985. Revised August 6, 1985. Accepted August 20, 1985.


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