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Ahmadi A, Sabri MR, Navabi ZS, Dehghan B, Taheri M, Mahdavi C. The Impact of Self-Care Recommendations with and without Tilt-Training on Quality of Life in Children and Adolescents with Vasovagal Syncope: A Randomized Clinical Trial. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2024; 29:358-367. [PMID: 39100396 PMCID: PMC11296608 DOI: 10.4103/ijnmr.ijnmr_137_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/19/2023] [Accepted: 03/03/2024] [Indexed: 08/06/2024]
Abstract
Background Syncope is among the most common paroxysmal disorders in children and adolescents. Vasovagal syncope is the most common syncope in children and adolescents. The aim of this study was to evaluate the impact of self-care recommendations with and without tilt training on the Quality of Life (QoL) of children and adolescents with syncope. Materials and Methods This randomized controlled clinical trial was conducted in Isfahan, Iran, from April 2017 to June 2021 and included 120 patients with syncope. Eligible children and adolescents (aged 6-18 years) who met inclusion criteria were recruited by the simple sampling method and then assigned randomly into two groups. The intervention group (n = 60) received routine self-care recommendations such as dietary advice, behaviors to prevent syncope, and counter-pressure maneuvers along with tilt training, while the control group (n = 60) received self-care recommendations without tilt training. The education training included two face-to-face sessions, each of which lasted for 45-60 min. Then, both groups were followed up by telephone (once a month) for six months. A researcher-made self-care questionnaire and Pediatric Quality of Life Inventory (PedsQL™ 4.0) were completed for both groups before and after the intervention. Data were analyzed using descriptive and inferential statistical methods. Results The Wilcoxon test results showed a significant difference in the mean scores of physical functioning, emotional functioning, social functioning, school functioning, psychosocial functioning, understanding of health, and total QoL in the intervention and control groups before and after the intervention (p < 0.05). Also, the paired t-test results showed a significant difference in the mean scores of self-care domains and total self-care in the intervention and control groups before and after the intervention (p < 0.05). Conclusions Self-care recommendations with and without tilt training can improve QoL in children and adolescents with syncope.
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Affiliation(s)
- Alireza Ahmadi
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Sabri
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zohreh Sadat Navabi
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahar Dehghan
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Taheri
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Chehre Mahdavi
- Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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2
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Raj P, Lei L, Flevaris P, Raj S, Sheldon R. Serotonin reuptake inhibition for the prevention of vasovagal syncope: a systematic review and meta-analysis. Clin Auton Res 2023; 33:811-819. [PMID: 37971641 DOI: 10.1007/s10286-023-01000-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Vasovagal syncope is a common clinical condition that lacks effective medical therapies despite being associated with significant morbidity. Current guidelines suggest that serotonin-specific reuptake inhibitors might suppress vasovagal syncope but supporting studies have been small and heterogenous. The purpose of this study was to evaluate the efficacy of serotonin-specific reuptake inhibitors to prevent syncope in patients with recurrent vasovagal syncope by conducting a systematic review and meta-analysis of published studies. METHODS Relevant randomized controlled trials were identified from the MEDLINE and Embase databases without language restriction from inception to August 2022, and ClinicalTrials.gov. All studies were conducted in clinical syncope populations and compared the benefit of serotonin versus placebo. Weighted relative risks were estimated using random effects meta-analysis techniques. RESULTS Three studies (n = 204) met inclusion criteria. Patients were 42 ± 13 years of age and 51% female. Serotonin-specific reuptake inhibitors were found to substantially reduce the likelihood of a patient having at least one recurrence of vasovagal syncope [relative risk (RR) 0.34 (0.20-0.60), p < 0.01] with minimal between-study heterogeneity (I2 = 0%, p = 0.67). Serotonin-specific reuptake inhibitors in two reports provided significant protection against clinical presyncope [RR 0.43 (0.24-0.77), p < 0.01], with minimal between-study heterogeneity (I2 = 0%, p = 0.80). CONCLUSIONS Serotonin-specific reuptake inhibitors may be effective in preventing syncope induced by head-up tilt testing and in syncope in the community in randomized, double-blinded clinical trials.
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Affiliation(s)
- Priya Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, GAA02 HRIC Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Lucy Lei
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, GAA02 HRIC Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Panagiota Flevaris
- 2nd Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Satish Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, GAA02 HRIC Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Robert Sheldon
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, GAA02 HRIC Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
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Soni B, Gupta D, Gopinathannair R. Quality of life improvement following cardioneuroablation for vasovagal syncope: expected or too early to say? J Interv Card Electrophysiol 2023:10.1007/s10840-023-01489-w. [PMID: 36705871 DOI: 10.1007/s10840-023-01489-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/17/2023] [Indexed: 01/28/2023]
Affiliation(s)
- Bosky Soni
- Department of Medicine, University of Pittsburgh School of Medicine, Harrisburg, PA, USA
| | - Dhiraj Gupta
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
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Piotrowski R, Baran J, Sikorska A, Krynski T, Kulakowski P. Cardioneuroablation for Reflex Syncope: Efficacy and Effects on Autonomic Cardiac Regulation-A Prospective Randomized Trial. JACC Clin Electrophysiol 2023; 9:85-95. [PMID: 36114133 DOI: 10.1016/j.jacep.2022.08.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/05/2022] [Accepted: 08/15/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Treatment of cardioinhibitory vasovagal syncope (VVS) is difficult. Recently, cardioneuroablation (CNA) has emerged as a new therapeutic option. OBJECTIVES This study sought to assess the effects of CNA on syncope recurrences in patients with VVS. METHODS This study was a prospective, open, randomized, controlled, investigator-initiated trial comparing CNA versus optimal nonpharmacologic therapy in patients with cardioinhibitory VVS. Patients were included if they had documented symptomatic cardioinhibitory or mixed VVS and positive atropine test. CNA was performed using radiofrequency ablation of the ganglionated plexi from the left and right atria. Follow-up lasted 2 years. Primary endpoint was time to first syncope recurrence. Secondary endpoints included changes in sinus rhythm and heart rate variability measured in Holter electrocardiography at baseline and 3, 12, and 24 months after CNA, as well as changes in quality of life at baseline and after completion of follow-up. RESULTS A total of 48 patients (17 male, mean age 38 ± 10 years, 24 in CNA group, 24 in control group) entered the study. The primary endpoint occurred in 2 patients (8%) from the CNA group versus 13 control patients (54%) (P = 0.0004). After CNA the mean sinus rhythm at 24-hour Holter electrocardiography was significantly faster and heart rate variability parameters significantly changed toward parasympathetic withdrawal compared with baseline values. Quality of life significantly improved in the CNA group (30 ± 10 points vs 10 ± 7 points; P = 0.0001), whereas it remained stable in control patients (31 ± 10 points vs 30 ± 10 points; P = 0.5501). CONCLUSIONS This is the first randomized study documenting efficacy of CNA in patients with cardioinhibitory VVS. Larger studies are needed to confirm these findings. (Cardioneuroablation for Reflex Syncope [ROMAN]; NCT03903744).
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Affiliation(s)
- Roman Piotrowski
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland.
| | - Jakub Baran
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Agnieszka Sikorska
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Tomasz Krynski
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Piotr Kulakowski
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
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Aghajani F, Tavolinejad H, Sadeghian S, Bozorgi A, Jalali A, Vasheghani‐Farahani A, Yadangi S, Niazi S, Poopak A, Tajdini M. Implementation of supervised physical training to reduce vasovagal syncope recurrence: a randomized controlled trial. J Cardiovasc Electrophysiol 2022; 33:1863-1870. [DOI: 10.1111/jce.15578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/06/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Faezeh Aghajani
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Hamed Tavolinejad
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Saeed Sadeghian
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Ali Bozorgi
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Arash Jalali
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Ali Vasheghani‐Farahani
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Somayeh Yadangi
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Sepideh Niazi
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Amirhossein Poopak
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Masih Tajdini
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
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Jorge J, Raj S, Liang Z, Sheldon R. Quality of life and injury due to vasovagal syncope. Clin Auton Res 2022; 32:147-149. [PMID: 35254551 DOI: 10.1007/s10286-022-00856-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/02/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Juliana Jorge
- Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Satish Raj
- Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Zhiying Liang
- Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Robert Sheldon
- Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
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Hockin BCD, Heeney ND, Whitehurst DGT, Claydon VE. Evaluating the Impact of Orthostatic Syncope and Presyncope on Quality of Life: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:834879. [PMID: 35224062 PMCID: PMC8866568 DOI: 10.3389/fcvm.2022.834879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/17/2022] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Syncope (transient loss of consciousness and postural tone) and presyncope are common manifestations of autonomic dysfunction that are usually triggered by orthostasis. The global impact of syncope on quality of life (QoL) is unclear. In this systematic review, we report evidence on the impact of syncope and presyncope on QoL and QoL domains, identify key factors influencing QoL in patients with syncopal disorders, and combine available data to compare QoL between syncopal disorders and to population normative data. METHODS A comprehensive literature search of academic databases (MEDLINE (PubMed), Web of Science, CINAHL, PsycINFO, and Embase) was conducted (February 2021) to identify peer-reviewed publications that evaluated the impact of vasovagal syncope (VVS), postural orthostatic tachycardia syndrome (POTS), or orthostatic hypotension (OH) on QoL. Two team members independently screened records for inclusion and extracted data relevant to the study objectives. RESULTS From 12,258 unique records identified by the search, 36 studies met the inclusion criteria (VVS: n = 20; POTS: n = 13; VVS and POTS: n = 1; OH: n = 2); 12 distinct QoL instruments were used. Comparisons of QoL scores between patients with syncope/presyncope and a control group were performed in 16 studies; significant QoL impairments in patients with syncope/presyncope were observed in all studies. Increased syncopal event frequency, increased autonomic symptom severity, and the presence of mental health disorders and/or comorbidities were associated with lower QoL scores. CONCLUSION This review synthesizes the negative impact of syncope/presyncope on QoL and identifies research priorities to reduce the burden of these debilitating disorders and improve patient QoL.
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Affiliation(s)
- Brooke C. D. Hockin
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Natalie D. Heeney
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - David G. T. Whitehurst
- International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Victoria E. Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
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8
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Vasovagal Syncope Needs the "Expert Touch". JACC Clin Electrophysiol 2022; 8:150-151. [PMID: 35210070 DOI: 10.1016/j.jacep.2021.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 12/18/2022]
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Ballantyne BA, Letourneau-Shesaf S, Raj SR. Management of vasovagal syncope. Auton Neurosci 2021; 236:102904. [PMID: 34763249 DOI: 10.1016/j.autneu.2021.102904] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/27/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
Vasovagal syncope (VVS) is a very common form of fainting. Treatment begins with patient education about the mechanism of fainting, and the non-lethal nature of vasovagal syncope. In this article, we review several non-pharmacological approaches that form the foundation of our current treatments. These include increases in dietary salt and water intake, the use of compression garments, physical counter-maneuvers and tilt-training. When these approaches are inadequate, medications can sometimes be effective. While the evidence base for the pharmacological treatment of VVS is modest, recent trial data have found drugs to be useful in placebo-controlled randomized trials. For select patients, and those patients more refractory to medications, procedural treatments may be an option. In this review, we discuss the current state of evidence for the non-pharmacological and pharmacological treatments for VVS, as well as some novel, emerging therapies for VVS.
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Affiliation(s)
- Brennan A Ballantyne
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sevan Letourneau-Shesaf
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Satish R Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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Sheldon R, Faris P, Tang A, Ayala-Paredes F, Guzman J, Marquez M, Morillo CA, Krahn AD, Kus T, Ritchie D, Safdar S, Maxey C, Raj SR. Midodrine for the Prevention of Vasovagal Syncope : A Randomized Clinical Trial. Ann Intern Med 2021; 174:1349-1356. [PMID: 34339231 DOI: 10.7326/m20-5415] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recurrent vasovagal syncope is common, responds poorly to treatment, and causes physical trauma and poor quality of life. Midodrine prevents hypotension and syncope during tilt tests in patients with vasovagal syncope. OBJECTIVE To determine whether midodrine can prevent vasovagal syncope in usual clinical conditions. DESIGN Randomized, double-blind, placebo-controlled clinical trial. (ClinicalTrials.gov: NCT01456481). SETTING 25 university hospitals in Canada, the United States, Mexico, and the United Kingdom. PATIENTS Patients with recurrent vasovagal syncope and no serious comorbid conditions. INTERVENTION Patients were randomly assigned 1:1 to placebo or midodrine and followed for 12 months. MEASUREMENTS The primary outcome measure was the proportion of patients with at least 1 syncope episode during follow-up. RESULTS The study included 133 patients who had had a median of 6 syncope episodes in the prior year (median age, 32 years; 73% female). Compared with patients receiving placebo, fewer patients receiving midodrine had at least 1 syncope episode (28 of 66 [42%] vs. 41 of 67 [61%]). The relative risk was 0.69 (95% CI, 0.49 to 0.97; P = 0.035). The absolute risk reduction was 19 percentage points (CI, 2 to 36 percentage points), and the number needed to treat to prevent 1 patient from having syncope was 5.3 (CI, 2.8 to 47.6). The time to first syncope was longer with midodrine (hazard ratio, 0.59 [CI, 0.37 to 0.96]; P = 0.035; log-rank P = 0.031). Adverse effects were similar in both groups. LIMITATION Small study size, young and healthy patients, relatively short observation period, and high proportion of patients from 1 center. CONCLUSION Midodrine can reduce the recurrence of syncope in healthy, younger patients with a high syncope burden. PRIMARY FUNDING SOURCE The Canadian Institutes of Health Research.
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Affiliation(s)
- Robert Sheldon
- University of Calgary, Calgary, Alberta, Canada (R.S., P.F., C.A.M., D.R., S.S., C.M.)
| | - Peter Faris
- University of Calgary, Calgary, Alberta, Canada (R.S., P.F., C.A.M., D.R., S.S., C.M.)
| | - Anthony Tang
- University of Western Ontario, London, Ontario, Canada (A.T.)
| | | | - Juan Guzman
- McMaster University, Hamilton, Ontario, Canada (J.G.)
| | - Manlio Marquez
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico (M.M.)
| | - Carlos A Morillo
- University of Calgary, Calgary, Alberta, Canada (R.S., P.F., C.A.M., D.R., S.S., C.M.)
| | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.)
| | - Teresa Kus
- University of Montreal, Montreal, Quebec, Canada (T.K.)
| | - Debbie Ritchie
- University of Calgary, Calgary, Alberta, Canada (R.S., P.F., C.A.M., D.R., S.S., C.M.)
| | - Shahana Safdar
- University of Calgary, Calgary, Alberta, Canada (R.S., P.F., C.A.M., D.R., S.S., C.M.)
| | - Connor Maxey
- University of Calgary, Calgary, Alberta, Canada (R.S., P.F., C.A.M., D.R., S.S., C.M.)
| | - Satish R Raj
- University of Calgary, Calgary, Alberta, Canada, and Vanderbilt University School of Medicine, Nashville, Tennessee (S.R.R.)
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Ling L, Feng T, Xue X, Ling Z. Etiology, risk factors, and prognosis of patients with syncope: A single-center analysis. Ann Noninvasive Electrocardiol 2021; 26:e12891. [PMID: 34582604 PMCID: PMC8588369 DOI: 10.1111/anec.12891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/03/2021] [Accepted: 08/21/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To investigate the main causes, risk factors, and prognosis of patients hospitalized with syncope. METHODS The patients admitted due to syncope were included. We analyzed the etiology, risk factors, and prognosis of patients with an average follow-up of 15.3 months. RESULTS High-risk factors for cardiogenic syncope included age ≥60, male, hypertension, palpitation, troponin T-positive, abnormal ECG, CHD history, and syncope-related trauma. Mortality rate was 4.6%, recurrence rate of syncope was 10.5%, and the rehospitalization rate was 8.5%. Univariate analysis showed that prognosis of syncope was related to age ≥60 years old, hypertension, positive troponin T, abnormal electrocardiogram, and coronary heart disease (p < .05). Multivariate Cox proportional hazard analysis showed that age ≥60 years old (p = .021) and high-sensitivity troponin-positive (p = .024) were strongly related to the prognosis of syncope. Kaplan-Meier curve showed statistical difference in the survival rate between the groups divided by age ≥60 years (p = .028), hs-TnT-positive (p < .001), abnormal ECG (p = .027), and history of CHD (p = .020). CONCLUSION High-risk factors for cardiogenic syncope included age ≥60, male, hypertension, palpitation, troponin T-positive, abnormal ECG, CHD family history, and syncope-related trauma. Age, hypertension, troponin T-positive, abnormal ECG, and CHD history were associated with the prognosis of syncope.
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Affiliation(s)
- Lin Ling
- Department of Cardiovascular, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tingting Feng
- Department of Infection, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaofeng Xue
- Department of Surgical Medicine, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zicheng Ling
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
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12
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Jorge JG, Pournazari P, Raj SR, Maxey C, Sheldon RS. Frequency of injuries associated with syncope in the prevention of syncope trials. Europace 2021; 22:1896-1903. [PMID: 32954415 DOI: 10.1093/europace/euaa246] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/29/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Syncope can lead to injuries. We determined the frequency, severity, and predictors of injuries due to syncope in cohorts of syncope patients. METHODS AND RESULTS Participants were enrolled in the POST2 (fludrocortisone) and POST4 (midodrine) vasovagal syncope (VVS) randomized trials, and POST3 enrolled patients with bifascicular block and syncope. Injury was defined as minor (bruising, abrasions), moderate (lacerations), and severe (fractures, burns, joint pain), and recorded up to 1 year after enrolment. A total of 459 patients (median 39 years) were analysed. There were 710 faints occurred in 186 patients during a 1-year follow-up. Fully 56/186 (30%) of patients were injured with syncope (12% of overall group). There were 102 injuries associated with the 710 faints (14%), of which 19% were moderate or severe injuries. Neither patient age, sex, nor the presence of prodromal symptoms associated with injury-free survival. Patients with bifascicular block were more prone to injury (relative risk 1.98, P = 0.018). Patients with ≥4 faints in the prior year had more injuries than those with fewer faints (relative risk 2.97, P < 0.0001), but this was due to more frequent syncope, and not more injuries per faint. In VVS patients, pharmacological therapy significantly reduced the likelihood of an injury due to a syncopal spell (relative risk 0.64, P = 0.015). Injury severity did not associate with age, sex, or prior-year syncope frequency. CONCLUSION Injuries are frequent in syncope patients, but only 4% of injuries were severe. None of age, sex, and prodromal symptoms associate with injury.
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Affiliation(s)
- Juliana G Jorge
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Payam Pournazari
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Satish R Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Connor Maxey
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Robert S Sheldon
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
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Doman ER, Kisling AJ, Fentanes E. An Atypical Case of Vasovagal Cardioinhibitory Syncope in a Young Male Soldier-Stand Up, Be Counted. JAMA Intern Med 2020; 180:1518-1520. [PMID: 32865544 DOI: 10.1001/jamainternmed.2020.3023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Elizabeth R Doman
- Department of Medicine, Tripler Army Medical Center, Honolulu, Hawaii
| | - Adam J Kisling
- Department of Medicine, Tripler Army Medical Center, Honolulu, Hawaii
| | - Emilio Fentanes
- Department of Medicine, Tripler Army Medical Center, Honolulu, Hawaii.,Cardiology Service, Tripler Army Medical Center, Honolulu, Hawaii
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Syncope in Malaysian populations. Clin Auton Res 2020; 30:101-103. [DOI: 10.1007/s10286-019-00663-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 12/25/2019] [Indexed: 10/25/2022]
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Barón-Esquivias G, Moya-Mitjans A, Martinez-Alday J, Ruiz-Granell R, Lacunza-Ruiz J, Garcia-Civera R, Gutiérrez-Carretero E, Romero-Garrido R, Morillo CA. Impact of dual-chamber pacing with closed loop stimulation on quality of life in patients with recurrent reflex vasovagal syncope: results of the SPAIN study. Europace 2019; 22:314-319. [DOI: 10.1093/europace/euz294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/01/2019] [Indexed: 12/26/2022] Open
Abstract
Abstract
Aims
Reflex vasovagal syncope (VVS) is the most common cause of syncope and patients with recurrent episodes may severely impair quality of life (QoL). This pre-specified analysis evaluated whether the clinically significant reduction in syncope burden demonstrated by dual-chamber pacing with closed loop stimulation (DDD-CLS) reported in the SPAIN trial translates into improved QoL.
Methods and results
Patients aged ≥40 years with ≥5 VVS episodes and cardioinhibitory response induced by head-up tilt testing were included. Patients were randomized 1:1 to active DDD-CLS pacing algorithm for 12 months followed by sham DDI mode for the remaining 12 months (Group A) or vice versa (Group B). QoL was assessed using the Short Form-36 (SF-36) health survey, Physical Component Score (PCS), and Mental Component Score (MCS) before randomization (baseline) and at 12- and 24-month follow-up. Fifty-four patients were enrolled from 11 participating centres. No significant carryover effect was detected for any variable, and the only period effect was observed in the vitality subdomain (P = 0.033). Mean SF-36 scores were higher in the DDD-CLS group vs. the DDI group for the eight subdomains and significantly different in physical role, bodily pain, and vitality (P < 0.05). The analysis of component summary scores indicated that DDD-CLS benefited both mental and physical components with significant differences in PCS when compared with the DDI group.
Conclusion
Dual-chamber pacing with closed loop stimulation determined a significant and clinically relevant improvement in QoL across both mental and physical components in patients with recurrent VVS.
Registration
Closed Loop Stimulation for Neuromediated Syncope (SPAIN Study); NCT01621464.
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Affiliation(s)
- Gonzalo Barón-Esquivias
- Department of Cardiology, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla. Av. Manuel Siurot, S/n, 41013 Sevilla, Spain
- Agencia de Investigación de la Sociedad Española de Cardiología, Madrid, Spain
| | - Angel Moya-Mitjans
- Agencia de Investigación de la Sociedad Española de Cardiología, Madrid, Spain
- Department of Cardiology, Hospital Universitario Vall d’Hebron, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Jesús Martinez-Alday
- Agencia de Investigación de la Sociedad Española de Cardiología, Madrid, Spain
- Department of Cardiology, Hospital Universitario Basurto, Montevideo Etorb., 18, 48013 Bilbao, Spain
- Department of Cardiology, Clínica IMQ Zorrotzaurre, Ballets Olaeta, 4, 48014 Bilbao, Spain
| | - Ricardo Ruiz-Granell
- Agencia de Investigación de la Sociedad Española de Cardiología, Madrid, Spain
- Department of Cardiology, Hospital Universitario Clínico de Valencia, Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain
| | - Javier Lacunza-Ruiz
- Agencia de Investigación de la Sociedad Española de Cardiología, Madrid, Spain
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 Murcia, Spain
| | - Roberto Garcia-Civera
- Agencia de Investigación de la Sociedad Española de Cardiología, Madrid, Spain
- Department of Cardiology, Hospital Universitario Clínico de Valencia, Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain
| | - Encarnación Gutiérrez-Carretero
- Department of Cardiology, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla. Av. Manuel Siurot, S/n, 41013 Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Rafael Romero-Garrido
- Department of Cardiology, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla. Av. Manuel Siurot, S/n, 41013 Sevilla, Spain
- Agencia de Investigación de la Sociedad Española de Cardiología, Madrid, Spain
- Department of Cardiology, Hospital Nuestra Señora de la Candelaria, Ctra. Gral. del Rosario, 145, 38010 Santa Cruz de Tenerife, Spain
| | - Carlos A Morillo
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1 and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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