Annales de cardiologie et d'angéiologie
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When a patient with a cardiac pacemaker presents with syncope or faintness, one's first thought should be failure of the pacemaker. If the abnormality is not apparent, the patient needs a full cardiological investigation, including "active" electrocardiographic recordings: magnet test, programming, or even Holter monitor should be performed in order to exclude the responsibility of the pacemaker. ⋯ Programming of the pacemaker can avoid further operation and can relieve the syncope: acceleration to prevent twisting of the apex, increase in the power of the impulses to eliminate the defects in stimulation due, for example, to a rise in the threshold. The syncope may also be caused by an extracardiac cause: associated pathology or useless implantation; the simplicity of implantation techniques sometimes means that pacemakers are implanted in inappropriate cases.