Vasovagal syncope is generally benign but may associated to pacing indication. We report two cases of vasovagal requiring pacemaker implantation. A leadless pacemaker was preferred to conventional pacing. Clinical cases: two women aged 24 and 16, were showing repetitive faintness. They presented prodromal symptoms, without triggering factor, that lead to collapse accompanied by convulsions or serious traumas. After a full neurological check-up and elimination of underlying cardiopathy, the diagnosis of vagal syncope with major cardioinhibitory component was made: for one through an implantable loop recorder with sinusal pauses of more than one minute, for the other with a positive tilt test and demonstration of a 18seconds sinusal pause on a 72h Holter ECG. The postural and the beta-blocker treatment being inefficient, pacing was decided. A Medtronic MICRA was implanted, via the right femoral vein, on the interventricular septum. Mean procedure time was 50minutes. Micra was positioned at the first attempt in both patients with thresholds <0.5V. No complications were observed and both patients were treated in our outpatient clinic. No syncope occurred since then in both patients over a follow-up of 2 and 12 months without significant change in electrical parameters.

Even if the DDDR pacing is to be favoured as first intention in this indication, the new leadless pacemakers show many advantages: no surgical approach, infections and haemorrhages decrease, displacement risk decrease, aesthetic keeping up with a same longevity to current simple room pacemakers. Thus, leadless pacemaker can be discussed for young patients with indication for pacing associated to vagal syncope. However, data is lacking in these patients, particularly concerning long-term follow-up.