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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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2
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Vanam S, Chindhy S, Han FT, Shen J. Recurrent syncope resulting from large carotid atheroma. HeartRhythm Case Rep 2021; 7:106-108. [PMID: 33665112 PMCID: PMC7897741 DOI: 10.1016/j.hrcr.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Sai Vanam
- Department of Medicine, Division of Cardiology, Cardiac Electrophysiology, University of California San Diego, La Jolla, California
| | - Shahzad Chindhy
- Department of Medicine, Division of Cardiology, Cardiac Electrophysiology, University of California San Diego, La Jolla, California
| | - Frederick T. Han
- Department of Medicine, Division of Cardiology, Cardiac Electrophysiology, University of California San Diego, La Jolla, California
| | - Jia Shen
- Department of Medicine, Division of Cardiology, Cardiac Electrophysiology, University of California San Diego, La Jolla, California
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3
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Sandhu RK, Raj SR, Thiruganasambandamoorthy V, Kaul P, Morillo CA, Krahn AD, Guzman JC, Sheldon RS, Banijamali HS, MacIntyre C, Manlucu J, Seifer C, Sivilotti M. Canadian Cardiovascular Society Clinical Practice Update on the Assessment and Management of Syncope. Can J Cardiol 2020; 36:1167-1177. [PMID: 32624296 DOI: 10.1016/j.cjca.2019.12.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/19/2019] [Accepted: 12/22/2019] [Indexed: 10/23/2022] Open
Abstract
Syncope is a symptom that occurs in multiple settings and has a variety of underlying causes, ranging from benign to life threatening. Determining the underlying diagnosis and prognosis can be challenging and often results in an unstructured approach to evaluation, which is ineffective and costly. In this first ever document, the Canadian Cardiovascular Society (CCS) provides a clinical practice update on the assessment and management of syncope. It highlights similarities and differences between the 2017 American College of Cardiology/American Heart Association/Heart Rhythm Society and the 2018 European Society of Cardiology guidelines, draws on new data following a thorough review of medical literature, and takes the best available evidence and clinical experience to provide clinical practice tips. Where appropriate, a focus on a Canadian perspective is emphasized in order to illuminate larger international issues. This document represents the consensus of a Canadian panel comprised of multidisciplinary experts on this topic with a mandate to formulate disease-specific advice. The primary writing panel wrote the document, followed by peer review from the secondary writing panel. The CCS Guidelines Committee reviewed and approved the statement. The practice tips represent the consensus opinion of the primary writing panel authors, endorsed by the CCS. The CCS clinical practice update on the assessment and management of syncope focuses on epidemiology, the initial evaluation including risk stratification and disposition from the emergency department, initial diagnostic work-up, management of vasovagal syncope and orthostatic hypotension, and syncope and driving.
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Affiliation(s)
| | - Roopinder K Sandhu
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
| | - Satish R Raj
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Padma Kaul
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Carlos A Morillo
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Juan C Guzman
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robert S Sheldon
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Hamid S Banijamali
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Ciorsti MacIntyre
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jaimie Manlucu
- Division of Cardiology, Western University, London, Ontario, Canada
| | - Colette Seifer
- Division of Cardiology, University of Winnipeg, Winnipeg, Manitoba, Canada
| | - Marco Sivilotti
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
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4
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Parry SW. Should We Ever Pace for Carotid Sinus Syndrome? Front Cardiovasc Med 2020; 7:44. [PMID: 32391383 PMCID: PMC7188762 DOI: 10.3389/fcvm.2020.00044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/06/2020] [Indexed: 12/16/2022] Open
Abstract
Carotid sinus syndrome has been associated with transient loss of consciousness for millennia, and while steeped in cardiovascular lore, there is little in the way of solid evidence to guide its main treatment modality, permanent cardiac pacing. This article reviews the history of the condition in the context of its contemporary understanding before examining three key concepts in the consideration of what constitutes a manageable disease: first, is there a pathophysiologic rationale for the disease (in this case carotid sinus syndrome)? Second, is there a good diagnostic test that will identify it reliably? And finally, is there a convincingly evidence-based treatment for the disease? Relevant literature is reviewed, and recommendations made in how we view pacing in the context of this intriguingly opaque condition.
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Affiliation(s)
- Steve W Parry
- Newcastle University Institute of Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom
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5
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Lacerda GDC, Lorenzo ARD, Tura BR, Santos MCD, Guimarães AEC, Lacerda RCD, Pedrosa RC. Long-Term Mortality in Cardioinhibitory Carotid Sinus Hypersensitivity Patient Cohort. Arq Bras Cardiol 2020; 114:245-253. [PMID: 32215492 PMCID: PMC7077571 DOI: 10.36660/abc.20190008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/15/2019] [Indexed: 11/18/2022] Open
Abstract
Background Cardioinhibitory carotid sinus hypersensitivity (CICSH) is defined as ventricular asystole ≥ 3 seconds in response to 5-10 seconds of carotid sinus massage (CSM). There is a common concern that a prolonged asystole episode could lead to death directly from bradycardia or as a consequence of serious trauma, brain injury or pause-dependent ventricular arrhythmias. Objective To describe total mortality, cardiovascular mortality and trauma-related mortality of a cohort of CICSH patients, and to compare those mortalities with those found in a non-CICSH patient cohort. Methods In 2006, 502 patients ≥ 50 years of age were submitted to CSM. Fifty-two patients (10,4%) were identified with CICSH. Survival of this cohort was compared with that of another cohort of 408 non-CICSH patients using Kaplan-Meier curves. Cox regression was used to examine the relation between CICSH and mortality. The level of statistical significance was set at 0.05. Results After a maximum follow-up of 11.6 years, 29 of the 52 CICSH patients (55.8%) were dead. Cardiovascular mortality, trauma-related mortality and the total mortality rate of this population were not statistically different from that found in 408 patients without CICSH. (Total mortality of CICSH patients 55.8% vs. 49,3% of non-CICSH patients; p: 0.38). Conclusion At the end of follow-up, the 52 CICSH patient cohort had total mortality, cardiovascular mortality and trauma-related mortality similar to that found in 408 patients without CICSH.
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Affiliation(s)
- Gustavo de Castro Lacerda
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brazil1.,Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brazil2
| | - Andrea Rocha de Lorenzo
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brazil1.,Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brazil2
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Goldberger ZD, Petek BJ, Brignole M, Shen WK, Sheldon RS, Solbiati M, Deharo JC, Moya A, Hamdan MH. ACC/AHA/HRS Versus ESC Guidelines for the Diagnosis and Management of Syncope. J Am Coll Cardiol 2019; 74:2410-2423. [DOI: 10.1016/j.jacc.2019.09.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 08/26/2019] [Accepted: 09/05/2019] [Indexed: 01/07/2023]
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da Cunha GJL, Rocha BML, Gomes RV, Silva BV, Mendes G, Morais R, Araújo IF, Fonseca C. A systematic review on recurrent cardioinhibitory vasovagal syncope: Does pacing therapy break the fall? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1400-1407. [DOI: 10.1111/pace.13790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 07/04/2019] [Accepted: 08/18/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Gonçalo José Lopes da Cunha
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco XavierCentro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - Bruno Miguel Lopes Rocha
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco XavierCentro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - Rita Ventura Gomes
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco XavierCentro Hospitalar Lisboa Ocidental Lisbon Portugal
- Cardiology DepartmentHospital de Vila Franca de Xira Lisbon Portugal
| | - Beatriz Valente Silva
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco XavierCentro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - Gonçalo Mendes
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco XavierCentro Hospitalar Lisboa Ocidental Lisbon Portugal
- Internal Medicine Department, Hospital de São BernardoCentro Hospitalar de Setúbal Setúbal Portugal
| | - Rui Morais
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco XavierCentro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - Inês Fornelos Araújo
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco XavierCentro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - Cândida Fonseca
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco XavierCentro Hospitalar Lisboa Ocidental Lisbon Portugal
- NOVA Medical School, Faculdade de Ciências MédicasUniversidade Nova de Lisboa Lisbon Portugal
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Levine GN, O’Gara PT, Beckman JA, Al-Khatib SM, Birtcher KK, Cigarroa JE, de las Fuentes L, Deswal A, Fleisher LA, Gentile F, Goldberger ZD, Hlatky MA, Joglar JA, Piano MR, Wijeysundera DN. Recent Innovations, Modifications, and Evolution of ACC/AHA Clinical Practice Guidelines: An Update for Our Constituencies. J Am Coll Cardiol 2019; 73:1990-1998. [DOI: 10.1016/j.jacc.2019.02.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Aliwaiai M, Caceres-Figueroa PP, Del-Carpio Munoz F. A Moving Anecdote: Exercise-Induced Vasovagal Sinus Arrest. Am J Med 2019; 132:471-475. [PMID: 30503885 DOI: 10.1016/j.amjmed.2018.11.009] [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: 08/14/2018] [Revised: 11/21/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Mohammed Aliwaiai
- Department of Cardiology, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, Wis
| | | | - Freddy Del-Carpio Munoz
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.
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Gampa A, Upadhyay GA. Treatment of Neurocardiogenic Syncope: From Conservative to Cutting-edge. J Innov Card Rhythm Manag 2018; 9:3221-3231. [PMID: 32477815 PMCID: PMC7252686 DOI: 10.19102/icrm.2018.090702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 12/11/2017] [Indexed: 11/23/2022] Open
Abstract
Neurocardiogenic syncope is the most frequent cause of syncope in the general population. Many years have been spent on determining an effective treatment for this condition. Conventional treatment usually follows a tiered approach for neurocardiogenic syncope, as follows: first, lifestyle modification, including increased fluid intake and the introduction of physical counterpressure maneuvers, is tried; then the use of targeted pharmacologic therapy, particularly agents that support blood pressure or that drive blood pressure is attempted; and, finally, pacemaker implantation in patients with a predominant cardioinhibitory component to their syncopal episodes is performed. More recently, autonomic modulation with cardiac ganglion ablation has emerged as a promising treatment modality for patients refractory to traditional approaches. In this review, we sought to summarize the existing therapies for neurocardiogenic syncope and explore the latest research on new modalities of treatment.
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Affiliation(s)
- Amulya Gampa
- Department of Internal Medicine, the University of Chicago Medicine, Chicago, IL, USA
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Section of Cardiology, the University of Chicago Medicine, Chicago, IL, USA
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11
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Morita H. Editorial commentary: To pace, or not to pace in vasovagal syncope? Trends Cardiovasc Med 2018; 28:539-540. [PMID: 29970287 DOI: 10.1016/j.tcm.2018.06.005] [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: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
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Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2017; 70:620-663. [PMID: 28286222 DOI: 10.1016/j.jacc.2017.03.002] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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