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Tao C, Xu B, Liao Y, Li X, Jin H, Du J. Predictor of Syncopal Recurrence in Children With Vasovagal Syncope Treated With Metoprolol. Front Pediatr 2022; 10:870939. [PMID: 35463909 PMCID: PMC9024146 DOI: 10.3389/fped.2022.870939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the predictors for syncopal recurrence in a pediatric population with vasovagal syncope (VVS) treated with metoprolol. Study Design This study was conducted retrospectively among children suffering from VVS with or without syncopal recurrence. Data on the detailed medical history and auxiliary examinations were obtained from the electronic medical records. The risk factors for syncopal recurrence were studied by cox regression analyses and the corresponding best cutoff values were determined using receiver operating characteristic analysis. Kaplan-Meier curves were plotted to determine the trends of the syncopal recurrence-free survival rate. Results Forty-two consecutive VVS children were enrolled in the study. At the end of a median follow-up duration of 9.0 (4.8, 19.1) months, 12 patients (29%) experienced ≥1 syncopal episode. Cox regression analyses revealed that the number of previous syncopal episodes before treatment was a risk factor for syncopal recurrence (hazard ratio = 1.027, 95% confidence interval 1.009 - 1.045, P = 0.003). Moreover, 4 previous syncopal episodes were certified as the best cutoff value, and the Kaplan-Meier curves showed that the syncopal recurrence-free survival rate over time in patients with > 4 previous syncopal episodes was significantly lower than that in patients with ≤4 episodes (P = 0.019 at the log-rank test). Conclusion In a pediatric population with VVS while on the treatment of metoprolol, the number of previous syncopal episodes before treatment played a significant role in predicting syncopal recurrence.
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Affiliation(s)
- Chunyan Tao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Bowen Xu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ying Liao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xueying Li
- Department of Statistics, Peking University First Hospital, Beijing, China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences, Ministry of China, Beijing, China
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences, Ministry of China, Beijing, China
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Fish E, Barak Lanciano S, Shavit I, Palacci H, Chaiat C, Avivi I, Haber Kaptsenel E, Nussinovitch U. Venous capacitance and venous return in young adults with typical vasovagal syncope: a cross-sectional study. J Investig Med 2021; 70:402-408. [PMID: 34580160 DOI: 10.1136/jim-2021-001906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/04/2022]
Abstract
Vasovagal syncope (VVS) has a high prevalence in the general population and is associated with potential complications. There is limited information on the possible association between venous capacitance (VC) and venous return (VR), important determinants of preload and VVS. Since the tilt test was reported to yield a high rate of false positive results, the aim of this study was to evaluate whether abnormal VC and VR at baseline could predispose individuals to VVS.To this end, 88 young, healthy volunteers were recruited and classified to 26 (29.5%) who experienced typical VVS and 62 (70.5%) who did not. VC and VR were evaluated with a commercial device and plethysmography applied to the elevated legs. Maximum venous outflow (MVO), segmental venous capacitance (SVC) and MVO/SVC ratio were calculated and averaged.No significant differences between MVO (5.0±0.5 vs 5.6±0.8, p>0.05), SVC (6.0±0.5 vs 6.3±0.8, p>0.05) or MVO/SVC ratio (0.83±0.02 vs 0.86±0.03, p>0.05) were observed for the non-VVS and VVS volunteers, respectively. There was a significant association between a higher MVO and SVC values and a larger decrease in diastolic blood pressure with standing, although correlations were weak (R2=0.0582 and 0.0681, respectively).In conclusion, at baseline, VC and VR are not impaired in healthy volunteers with a history of VVS. It remains unknown if similar results would be found in patients with cardiovascular comorbidities. Also, the sensitivity of VC and VR evaluations to identify a predisposition for VVS following physiological provocations merits further study.
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Affiliation(s)
- Ely Fish
- Department of Psychiatry, Westchester Medical Center, Valhalla, NY, USA
| | | | - Itay Shavit
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagar Palacci
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chen Chaiat
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ishay Avivi
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Udi Nussinovitch
- Division of Cardiovascular Medicine, Stanford University, Palo Alto, CA, USA
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3
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Jorge JG, Raj SR, Teixeira PS, Teixeira JAC, Sheldon RS. Likelihood of injury due to vasovagal syncope: a systematic review and meta-analysis. Europace 2021; 23:1092-1099. [PMID: 33693816 DOI: 10.1093/europace/euab041] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Vasovagal syncope (VVS) is the most common type of syncope and is usually considered a benign disorder. The potential for injury is worrisome but the likelihood is unknown. We aimed to determine the proportion of patients injured due to VVS. METHODS AND RESULTS A systematic search of studies published until August 2020 was performed in multiple medical and nursing databases. Included studies had data on the proportion of patients with injury due to VVS prior to study enrolment. Random effects methods were used. Twenty-three studies having 3593 patients met inclusion criteria. Patients were diagnosed clinically with VVS, and 82% had >2 syncopal episodes before enrolment. Tilt test was positive in 60% and 14 studies reported comorbidities (32.6% hypertensive). The weighted mean injury rate was 33.5% [95% confidence interval (CI): 27.3-40.5%]. The likelihood of injury correlated with population age (r = 0.4, P = 0.05), but not with sex, positive tilt test, or hypertension. The injury rates were 25.7% (95% CI: 19.1-32.8%) in studies with younger patients (mean age ≤50 years, n = 1803) and 43.4% (95% CI: 34.9-52.3%) in studies with older patients (P = 0.002). Nine studies reported major injuries; with a weighted mean rate of major injuries of 13.9% (95% CI: 9.5-19.8%). CONCLUSION Injuries due to syncope are frequent, occurring in 33% of patients with VVS. The risk of major injuries is substantial. Older patients are at higher risk. Clinicians should be aware of the risk of injuries when providing care and advice to patients with VVS.
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Affiliation(s)
- Juliana G Jorge
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Satish R Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Pedro S Teixeira
- Clinica Fit Labor Centro de Performance Humana, Niteroi, Rio de Janeiro, Brazil
| | - Jose A C Teixeira
- Clinica Fit Labor Centro de Performance Humana, Niteroi, Rio de Janeiro, Brazil
| | - Robert S Sheldon
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
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Blendea D, McPherson CA, Pop S, Ruskin JN. Isolated very low QRS voltage in the frontal leads predicts recurrence of neurally mediated syncope. Heart Rhythm 2019; 16:1862-1869. [PMID: 31201963 DOI: 10.1016/j.hrthm.2019.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Indexed: 10/26/2022]
Abstract
BACKGROUND The study was prompted by our observation that some patients with neurally mediated syncope (NMS) have an isolated QRS complex, of very low voltage (≤0.3 mV cutoff), in 1 of the frontal leads on the 12-lead electrocardiogram. OBJECTIVE To prospectively evaluate whether the presence of isolated very low voltage (VLV) predicts recurrence of NMS. METHODS We included 205 patients (aged 50 ± 17 years) with a median of 3 syncopal episodes. Tilt testing was performed in all patients and was positive in 87 (42%). The patients were followed for a median of 14 months. RESULTS VLV in frontal leads was present in 92 patients (45%). During the follow-up period 60 patients experienced recurrence of syncope. The actuarial total syncope recurrence rate at 1 year was 32% (95% confidence interval [CI 23%-44%) in patients with isolated VLV in frontal plane leads, and 14% (95% CI 8%-24%) in patients without VLV (log-rank test P < .0001). The significant relationship between the presence of isolated VLV in the frontal leads and syncope recurrence was retained in Cox multivariate analysis that included the history of presyncope and syncope as well as the left ventricular end-diastolic diameter. The presence of isolated VLV in frontal leads was associated with a 3-fold increase of the risk of recurrent syncope. CONCLUSIONS Isolated very low QRS voltage in the frontal leads predicts recurrence of NMS independent of clinical factors that predict recurrence of syncope in such patients. This phenomenon may help generate new diagnostic tools and insights into the pathogenesis of NMS.
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Affiliation(s)
- Dan Blendea
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Emergency Clinical County Hospital, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
| | - Craig A McPherson
- Bridgeport Hospital, Yale University School of Medicine, Bridgeport, Connecticut
| | - Sorin Pop
- Emergency Clinical County Hospital, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Jeremy N Ruskin
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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5
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Choi YJ, Kang KW, Jang SH, Kim JG, Lee SJ, Jung KT. Heart rate recovery and diastolic blood pressure ratio on the treadmill test predict an induction and recurrence of vasovagal syncope. Korean J Intern Med 2019; 34:315-323. [PMID: 29240992 PMCID: PMC6406081 DOI: 10.3904/kjim.2017.180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/29/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The induction and recurrence of syncope is a concerning situation that could be unpredicted in the vasovagal syncope (VVS). We investigated a simple predictor for the induced and recurrent VVS during Head-Up table-tilt Test (HUT) and clinically follow-up. METHODS The 143 consecutive patients with VVS (age 31 ± 19 years, 33 male) who referred by a cardiologist or neurologist and had undergone an echocardiogram, HUT, and a treadmill exercise test (TMT) were recruited and clinically follow-up. Patients were divided into two groups based on the result of HUT and TMT. The data was analyzed and compared between VVS patients and control 141 patients without VVS who were enrolled in the same study period (age 40 ± 5 years, 117 male). RESULTS The heart rate recovery (HRR), recovery systolic blood pressure (RecSBP), recovery diastolic blood pressure (RecDBP), HRR/RecSBP and HRR/RecDBP were significantly different between controls and VVS during the TMT. Within VVS, even if, baseline characteristics were similar between negative and positive HUT (n = 92 vs. n = 51). HRR (31 ± 10 vs. 35 ± 10), HRR/RecSBP (0.24 ± 0.09 vs. 0.28 ± 0.09) and HRR/RecDBP (0.49 ± 0.18 vs. 0.58 ± 0.19) were significantly different between negative and positive HUT results. Especially, HRR/RecSBP and HRR/RecDBP were significantly correlated with induced syncope with a sensitivity and specificity ([60%, 83%] cut-off, 0.31; [72%, 80%] cut-off, 0.63). In the Cox regression, HRR/ RecDBP were significantly associated with recurrence of VVS with hazard ratio of 3.29 (confidence interval, 0.95 to 11.3; p = 0.049). CONCLUSION HRR/RecDBP may be a useful predictor for induction during HUT and recurrence during follow-up in the VVS.
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Affiliation(s)
- Yu Jeong Choi
- Division of Cardiology, Eulji University Hospital, Daejeon, Korea
| | - Ki-Woon Kang
- Division of Cardiology, Eulji University Hospital, Daejeon, Korea
- Correspondence to Ki-Woon Kang, MD. Division of Cardiology, Eulji University Hospital, 95 Dunsanseoro, Seo-gu, Daejeon 35233, Korea Tel: +82-42-611-3081 Fax: +82-42-611-3083 E-mail:
| | - Sang Hyun Jang
- Division of Neurology, Eulji University Hospital, Daejeon, Korea
| | - Jae Guk Kim
- Division of Neurology, Eulji University Hospital, Daejeon, Korea
| | - Soo Joo Lee
- Division of Neurology, Eulji University Hospital, Daejeon, Korea
| | - Kyung Tea Jung
- Division of Cardiology, Eulji University Hospital, Daejeon, Korea
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O'Brien B, Zafar H, Sharif F. Renal nerve stimulation for treatment of neurocardiogenic syncope: a review from perspective of commercialization potential. Ir J Med Sci 2017; 187:45-54. [PMID: 28616731 DOI: 10.1007/s11845-017-1643-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 05/26/2017] [Indexed: 10/19/2022]
Abstract
A strong evidence of outcomes for vasovagal syncope is not easily identified. It would seem reasonable that the proposed Mayo Clinic technology would be reserved for cases with severe recurrent or refractory syncope. However, recurrence levels are relatively low, and while some predictive methods have been proposed, recurrence is also influenced by the interaction that occurs during screening and examinations, i.e. recurrence diminishes once an initial diagnosis has been made. Finally, a key factor in being able to identify suitable patients relates to understanding the relative significance of the vasodepression and cardioinhibitory components-the therapy is best suited to patients that have a significant level of both components. It is probably not needed in patients with mainly cardioinhibitory involvement-data from ISSUE 2 and ISSUE 3 studies suggest that this is a relatively large proportion, particularly with asystolic involvement. The challenge remains in having suitable screening tests to identify the best patients. Tilt table testing has questions concerning its ability to replicate clinical syncope-implantable loop recorders (ILRs) may provide more accurate data but their usage is not yet widely accepted given the costs and invasive nature of the monitor.
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Affiliation(s)
- B O'Brien
- Biomedical Engineering, School of Engineering and Informatics, National University of Ireland (NUI) Galway, Galway, Ireland
| | - H Zafar
- Cardiovascular Research Centre Galway, School of Medicine, National University of Ireland Galway, Galway, Ireland. .,Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland.
| | - F Sharif
- Cardiovascular Research Centre Galway, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland.,Department of Cardiology, University Hospital Galway, Galway, Ireland.,BioInnovate Ireland, Galway, Ireland.,CÚRAM, SFI Centre for Research in Medical Devices, Galway, Ireland
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7
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High Remission Rates in Vasovagal Syncope: Systematic Review and Meta-Analysis of Observational and Randomized Studies. JACC Clin Electrophysiol 2016; 3:384-392. [PMID: 29759452 DOI: 10.1016/j.jacep.2016.10.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/27/2016] [Accepted: 10/20/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The aims of this study were to quantify the degree of improvement in vasovagal syncope after assessment and to identify predictive factors. BACKGROUND No treatments for vasovagal syncope have been proved effective, but patients in all prospective studies appear to show a reduction in the likelihood of fainting. METHODS A systematic review and meta-analysis was performed of studies published from 1993 through 2013. Inclusion criteria were: 1) vasovagal syncope frequency in the preceding 1 to 2 years; and 2) the proportion of subjects with syncope in at least the first follow-up year. Random-effects methods were used. RESULTS Of 338 screened studies, 17 were analyzed, with a mean of 112 subjects (range 9 to 511 subjects). In the preceding epoch, 97% of subjects fainted, with 2.6 ± 1.0 syncopal spells per year. In the follow-up year, the proportion of patients with ≥1 syncope recurrence was 677 of 1,912 (35.4%), and in the meta-analysis, the proportion of subjects fainting was only 0.44 (95% confidence interval: 0.41 to 0.46; p < 0.001). Subjects in larger studies were less likely to faint than those in randomized trials (relative risk: 0.35 vs. 0.55; p = 0.004). The probabilities of ≥1 syncope recurrence in the observational versus randomized studies were 0.30 (95% confidence interval: 0.24 to 0.37) and 0.54 (95% confidence interval: 0.46 to 0.62), respectively (p < 0.001). None of the degree of blinding, type of intervention, age, sex, and number of recent faints predicted the probability of syncope recurrence. Heterogeneity was very high in all analyses (I2 = 60% to 96%). CONCLUSIONS The spontaneous remission rate in highly symptomatic syncope patients is high, and remission occurs in all types of studies. Improvement was more likely in larger and observational studies.
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Ho D, Ghods M, Kumar S, Warrier N, Ilias Basha H, Budzikowski AS, Kassotis J. Early Hemodynamic Changes during Head-Up Tilt Table Testing Can Predict a Neurocardiogenic Response in an African-American Patient Population. Cardiology 2015; 133:223-32. [PMID: 26669563 DOI: 10.1159/000441971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/23/2015] [Indexed: 07/13/2024]
Abstract
BACKGROUND Head-up tilt table testing (HUTT) is time-consuming and associated with increased patient morbidity. Hemodynamic changes that occur during the early phase of HUTT may be predictive of neurocardiogenic syncope. METHODS A retrospective chart review was performed in 119 consecutive African Americans ( 57 ± 19) who underwent HUTT for evaluation of syncope of unknown etiology. Positive responses were defined as the development of symptoms linked with a systolic blood pressure (BP) <90 mm Hg, heart rate <50 b.p.m. or sinus arrest >3 s. Hemodynamic variables during the passive phase of HUTT were analyzed and results were then classified as a function of various predictors. RESULTS Sixty-two subjects (52%) had positive HUTT, and 57 (48%) had negative HUTT. Early changes in BP variables from baseline significantly predicted HUTT responses (p < 0.05). There was also a significant interaction between age and BP. An algorithm based on age and BP was developed which had positive and negative predictive values of 67.7 and 93%, respectively, with an accuracy of 79.8%. CONCLUSION A novel algorithm utilizing the patients' age and changes in both systolic and diastolic BP during the early phase of HUTT enables the prediction of HUTT results without the use of vasoactive stimulation, allowing for rapid diagnosis, decreased patient morbidity and reduction in costs.
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Affiliation(s)
- David Ho
- Division of Cardiology, Department of Medicine, University Hospital of Brooklyn, State University of New York at Downstate, Brooklyn, N.Y., USA
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Lee SH, Kim BS, Park SJ, On YK, Huh J, Kim JS. Clinical Factors Affecting Symptom Recurrence in Patients with Syncope. Cardiology 2014; 129:233-9. [DOI: 10.1159/000366267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 07/30/2014] [Indexed: 11/19/2022]
Abstract
<b><i>Purpose:</i></b> Recurrent syncope leads to poor functional status and psychiatric impairment in patients with syncope. The aim of the study was to prospectively analyze the risk factors attributed to syncope recurrence. <b><i>Materials and Methods:</i></b> Between 2009 and 2010, 289 patients with all cause of syncope visited our institution. Syncope recurrences were followed for 1 year by telephone interview every 3 months. <b><i>Results:</i></b> We diagnosed 181 (63%) patients with neurally mediated syncope (NMS), 39 (13%) with orthostatic hypotension, 34 (12%) with cardiac syncope, and 35 (12%) with unexplained syncope. During the 1-year follow-up period, 19 (6.6%) patients suffered recurrent syncope. Kaplan-Meier curves showed that recurrent syncope was observed more often in patients with unexplained syncope compared with those with NMS (p < 0.01), and also observed more often in patients with six previous syncopal episodes compared to those with fewer episodes (p = 0.02). Cox regression analysis showed that the recurrence of syncope was significantly associated with more than six previous syncopal episodes (HR 5.38, 95% CI 1.17-24.71, p = 0.03) and that there was a tendency for association between recurrence of syncope and unexplained syncope (HR 6.13, 95% CI 0.96-39.1, p = 0.05). <b><i>Conclusions:</i></b> Patients with previous frequent syncopal episodes or unexplained syncope had higher rates of syncope recurrence during the follow up period.
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Uhm JS, Youn HJ, Chung WB, Choi YS, Park CS, Oh YS, Chung WS, Park KI, Kim TS. Positive result in the early passive phase of the tilt-table test: a predictor of neurocardiogenic syncope in young men. Korean J Intern Med 2012; 27:60-5. [PMID: 22403501 PMCID: PMC3295990 DOI: 10.3904/kjim.2012.27.1.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 06/17/2011] [Accepted: 10/05/2011] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS This study elucidated the prognostic factors for neurocardiogenic syncope in males in their late teens and early twenties. METHODS Tilt-table testing (TTT) was performed on 665 males (age range, 17 to 27 years) following the Italian protocol. The subjects were tilted head-up at a 70° angle on a table for 30 minutes during the passive phase. If the passive phase was negative, the subjects were given sublingual nitroglycerin and tilted to the same angle for 20 minutes during the drug-provocation phase. The subjects with positive results were followed without medication. We analyzed factors related to the recurrence rate of syncope. RESULTS Of 305 subjects (45.8%) with positive results, 223 (age range, 18 to 26 years) were followed for 12 months. The frequency of previous syncopal episodes ≥ 4 (p = 0.001) and a positive result during the passive phase (p = 0.022) were significantly related to a high recurrence rate. A positive result during the early passive phase (≤ 12 minutes) was significantly related to a higher recurrence rate than was that during the late passive phase (> 12 minutes; p = 0.011). CONCLUSIONS A positive result during the early passive phase of TTT and frequent previous syncopal episodes were prognostic factors for neurocardiogenic syncope in men in their late teens and early twenties.
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Affiliation(s)
- Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Woo-Baek Chung
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Yun-Seok Choi
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Chul-Soo Park
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Yong-Seog Oh
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Wook-Sung Chung
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Kyung-Il Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Suk Kim
- Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
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Macedo P, Leite LR, Asirvatham SJ, Hachul DT, Dos Santos-Neto LL, Shen WK. Head Up Tilt Testing: An Appraisal of Its Current Role in the Management of Patients with Syncope. J Atr Fibrillation 2011; 4:333. [PMID: 28496692 DOI: 10.4022/jafib.333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 12/19/2010] [Accepted: 01/14/2011] [Indexed: 01/14/2023]
Abstract
Head up tilt testing (HTT) is now commonly used to investigate otherwise unexplained syncope and presyncope. This test has been used for over 20 years primarily to diagnose neurally mediated syncope, but HTT's exact role in the diagnostic process remains uncertain. Recognized limitations include poor reproducibility, lack of prognostic role, and insufficient randomized studies to guide therapeutic choice. In this review, we describe the indications and methods recommended by present guidelines on utilizing HTT. In addition, present criticisms and limitations of this test, along with future perspectives, are outlined.
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Affiliation(s)
- Paula Macedo
- Division of Cardiovascular Diseases, Department of Medicine
| | | | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Medicine.,Department of Pediatrics and Adolescent Medicine - Mayo Clinic, Rochester, Minnesota
| | | | | | - Win-Kuang Shen
- Division of Cardiovascular Diseases, Department of Medicine
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Romme JJCM, van Dijk N, Go-Schön IK, Casteelen G, Wieling W, Reitsma JB. Association between psychological complaints and recurrence of vasovagal syncope. Clin Auton Res 2011; 21:373-80. [PMID: 21547606 DOI: 10.1007/s10286-011-0125-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 04/06/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE Vasovagal syncope (VVS), the most common cause of transient loss of consciousness (T-LOC), is often accompanied by higher levels of psychological distress. We investigated to what extent psychological complaints interact with the effects of non-pharmacological treatment in patients with frequently recurring VVS. METHODS Patients with ≥3 episodes of VVS in the 2 years prior to the start of the study openly received non-pharmacological treatment. Before treatment initiation, we determined the level of general psychological complaints by the Symptom Checklist 90-R (SCL-90-R) questionnaire. We regularly evaluated syncopal recurrence during follow-up. We compared the SCL-90-R scores of VVS patients in our study with the corresponding scores of healthy Dutch subjects (reference population). We examined whether patients with more recurrences during follow-up had higher SCL-90-R scores at baseline and whether this association changed when adjusting for other factors associated with recurrence using logistic regression. RESULTS Total SCL-90-R scores were higher in our cohort of patients with frequent episodes of VVS than in the reference population (142 vs. 118; p < 0.001). During the first 6 months of treatment, 42% of patients experienced syncopal recurrence(s). The SCL-90-R scores of these patients were significantly higher compared with patients without syncopal recurrence in this period (160 vs. 130; p = 0.01). After adjusting for other predictors of recurrence, especially the number of episodes before inclusion, the association between SCL-90-R scores and recurrence remained intact. CONCLUSIONS Levels of general psychological complaints are higher in patients with syncopal recurrence during non-pharmacological treatment of VVS, even after adjusting for previous syncopal episodes.
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Affiliation(s)
- Jacobus J C M Romme
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
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Aydin MA, Salukhe TV, Wilke I, Willems S. Management and therapy of vasovagal syncope: A review. World J Cardiol 2010; 2:308-15. [PMID: 21160608 PMCID: PMC2998831 DOI: 10.4330/wjc.v2.i10.308] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 08/12/2010] [Accepted: 08/19/2010] [Indexed: 02/06/2023] Open
Abstract
Vasovagal syncope is a common cause of recurrent syncope. Clinically, these episodes may present as an isolated event with an identifiable trigger, or manifest as a cluster of recurrent episodes warranting intensive evaluation. The mechanism of vasovagal syncope is incompletely understood. Diagnostic tools such as implantable loop recorders may facilitate the identification of patients with arrhythmia mimicking benign vasovagal syncope. This review focuses on the management of vasovagal syncope and discusses the non-pharmacological and pharmacological treatment options, especially the use of midodrine and selective serotonin reuptake inhibitors. The role of cardiac pacing may be meaningful for a subgroup of patients who manifest severe bradycardia or asystole but this still remains controversial.
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Affiliation(s)
- Muhammet Ali Aydin
- Muhammet Ali Aydin, Tushar V Salukhe, Iris Wilke, Stephan Willems, Department of Electrophysiology, University Heart Center Hamburg, Martinistraße 52, Hamburg 20246, Germany
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Iacoviello M, Forleo C, Guida P, Sorrentino S, D'Andria V, Rodio M, D'Alonzo L, Favale S. Independent role of reduced arterial baroreflex sensitivity during head-up tilt testing in predicting vasovagal syncope recurrence. Europace 2010; 12:1149-55. [PMID: 20488858 DOI: 10.1093/europace/euq149] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The involvement of arterial baroreflex function in the pathophysiology of vasovagal syncope (VVS) is controversial, and there are no published data supporting its clinical usefulness. The aim of this study was to evaluate the role of arterial baroreflex sensitivity (BRS) at baseline and during head-up tilt testing (HUT) in predicting the recurrence of VVS. METHODS AND RESULTS The study involved otherwise healthy patients with a history of unexplained syncope who underwent diagnostic HUT by being tilted to 70 degrees after 10 min supine rest; the test was potentiated by the administration of 300 microg of nitroglycerine (NTG) after 20 min. Beat-to-beat heart rate and systolic blood pressure were continuously recorded, and the sequence method was used to measure arterial baroreflex control of heart rate. The 190 enrolled patients were followed up for 18 +/- 6 months, during which 34 experienced a total of 90 episodes of syncope recurrence. In a stepwise multivariate analysis, female gender [hazard ratio (HR): 2.74; P = 0.008], the presence of >or=3 syncope events before HUT (HR: 3.36; P = 0.004), and BRS below median value after the start of HUT or after the administration of NTG (HR: 3.79; P = 0.006) were significantly and independently associated with the recurrence of syncope. Moreover, when a BRS value of less than the median was added to the other independent factors in a stepwise model, a significant increase in discrimination (C-index: 0.77) and model fitting (P = 0.001) was observed. CONCLUSION Reduced BRS during HUT has independent and incremental value in predicting the recurrence of syncope, thus supporting its potential usefulness in the clinical management of patients.
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Affiliation(s)
- Massimo Iacoviello
- Cardiology Unit, Emergency and Organ Transplantation Department, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
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The year in arrhythmias—2009 Part II. Heart Rhythm 2010; 7:538-48. [DOI: 10.1016/j.hrthm.2010.01.002] [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: 11/09/2009] [Indexed: 11/21/2022]
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Clinical predictors of head-up tilt test outcome during the nitroglycerin phase. Clin Auton Res 2009; 20:167-73. [DOI: 10.1007/s10286-009-0020-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 06/10/2009] [Indexed: 11/26/2022]
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