Use of a Temporary Pacemaker During Cesarean Section in a Pregnant Patient With Neurally Mediated Syncope: A Case Report.

A 39-year-old pregnant woman with a history of neurally mediated syncope (NMS) and a documented eight-second sinus arrest on her Holter electrocardiography (ECG) was scheduled for cesarean delivery. A temporary pacemaker (PM) was inserted preoperatively to prevent severe bradycardia. Combined epidural and spinal anesthesia (CESA) was carried out. Intraoperatively, severe bradycardia triggered PM activation. Prompt administration of ephedrine and atropine sulfate stabilized her vital signs, and the PM was deactivated within two minutes. The cesarean section proceeded without further complications, and both mother and neonate had favorable outcomes. The PM was removed on postoperative day 2, and no syncope episodes were observed during hospitalization or follow-up. This case demonstrates the effectiveness of temporary PM use in preventing severe bradycardia during cesarean section in a patient with NMS. Multidisciplinary planning and individualized hemodynamic management are essential for achieving safe delivery outcomes in high-risk pregnancies complicated by reflex syncope.