{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T08:44:42Z","timestamp":1773045882837,"version":"3.50.1"},"reference-count":5,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,9,5]]},"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:p>The current evidence for vasovagal syncope management is that cardiac pacing is only indicated in a highly select group of patients where symptoms can be linked to bradycardic episodes. High spinal cord injury can lead to autonomic dysfunction and sympathetic nervous system hypoactivity. A high spinal cord injury can theoretically precipitate profound bradycardia leading to haemodynamic instability and syncope. A patient in his 50s with a history of C2 spinal injury was admitted to our tertiary centre for management of what was initially thought to be septic shock causing hypotension and syncope. With evidence to suggest this patient\u2019s presentation may be profound reflex syncope in the context of unopposed parasympathetic signalling, consensus was reached to implant a permanent pacemaker. Remarkably, the patient\u2019s haemodynamics stabilised and there were no further episodes of syncope.<\/jats:p>","DOI":"10.1136\/bcr-2023-255020","type":"journal-article","created":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T12:45:39Z","timestamp":1696941939000},"page":"e255020","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["High spinal cord injury precipitating syncope: a rare indication for pacemaker insertion"],"prefix":"10.1136","volume":"16","author":[{"given":"Isa","family":"Khan","sequence":"first","affiliation":[{"name":"Cardiology, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1104-3511","authenticated-orcid":false,"given":"Timothy G","family":"Scully","sequence":"additional","affiliation":[{"name":"Cardiology, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew W","family":"Teh","sequence":"additional","affiliation":[{"name":"Cardiology, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoffrey R","family":"Wong","sequence":"additional","affiliation":[{"name":"Cardiology, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,10,10]]},"reference":[{"key":"2025082801141737000_16.10.e255020.1","doi-asserted-by":"publisher","DOI":"10.1682\/JRRD.2005.10.0159"},{"key":"2025082801141737000_16.10.e255020.2","doi-asserted-by":"crossref","first-page":"28","DOI":"10.15420\/aer.2015.4.1.28","article-title":"Biology of the sinus node and its disease","volume":"4","author":"Choudhury","year":"2015","journal-title":"Arrhythm Electrophysiol Rev"},{"key":"2025082801141737000_16.10.e255020.3","doi-asserted-by":"crossref","first-page":"4295","DOI":"10.1093\/eurheartj\/ehab699","article-title":"The '10 commandments' for the 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy","volume":"42","author":"Michowitz","year":"2021","journal-title":"Eur Heart J"},{"key":"2025082801141737000_16.10.e255020.4","doi-asserted-by":"crossref","first-page":"427","DOI":"10.4103\/1793-5482.146394","article-title":"Prolonged bradycardia, asystole and outcome of high spinal cord injury patients: risk factors and management","volume":"11","author":"Shaikh","year":"2016","journal-title":"Asian J Neurosurg"},{"key":"2025082801141737000_16.10.e255020.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0026489","article-title":"Physiological phenomenology of neurally-mediated syncope with management implications","volume":"6","author":"Schroeder","year":"2011","journal-title":"PLoS One"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-255020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:14:21Z","timestamp":1756368861000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-255020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10]]},"references-count":5,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10,10]]},"published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1136\/bcr-2023-255020"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-255020","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10]]}}}