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Risk stratification of sudden cardiac death in Brugada syndrome: an updated review of literature. Egypt Heart J 2022; 74:25. [PMID: 35404008 PMCID: PMC9001772 DOI: 10.1186/s43044-022-00267-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/05/2022] [Indexed: 11/16/2022] Open
Abstract
Brugada syndrome is a rare but serious inherited heart disease that causes sudden cardiac death by polymorphic ventricular tachycardia or ventricular fibrillation. It is an autosomal dominant genetic disease that usually occurs in patients in their forties with a structurally normal heart. Electrically, it manifests by ST elevation segment ≥ 2 mm of at least one right precordial lead (V1 and/or V2). Stratification of sudden cardiac death in Brugada syndrome is not always easy and constitutes a real challenge for the practitioner. In this review, we will present the current state of knowledge for arrhythmic risk stratification and the prevention of sudden cardiac death that can result from this syndrome.
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Micturition syncope with asystole in a paediatric patient. Cardiol Young 2021; 31:661-662. [PMID: 33308342 DOI: 10.1017/s1047951120004473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Syncope occurs frequently in children, and the differential includes situational syncope, specifically micturition syncope. We report the youngest child to our knowledge to have micturition syncope associated with a prolonged asystolic pause. He underwent a neurological and cardiovascular evaluation without additional findings. Behavioural modifications were instituted with no recurrent syncope.
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Auerbach AJ. Micturition Syncope: A Personal Experience With a Novel Explanation. Ann Emerg Med 2020; 75:312-313. [DOI: 10.1016/j.annemergmed.2019.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Indexed: 10/25/2022]
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Adkisson WO, Benditt DG. Pathophysiology of reflex syncope: A review. J Cardiovasc Electrophysiol 2018; 28:1088-1097. [PMID: 28776824 DOI: 10.1111/jce.13266] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/25/2017] [Accepted: 05/26/2017] [Indexed: 12/15/2022]
Abstract
In this correspondence, the pathophysiology of reflex syncope (vasovagal syncope, carotid sinus syndrome, and situational syncope) is reviewed, including clarification of the nomenclature.
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Affiliation(s)
- Wayne O Adkisson
- Cardiac Arrhythmia and Syncope Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - David G Benditt
- Cardiac Arrhythmia and Syncope Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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Olde Nordkamp LRA, Vink AS, Wilde AAM, de Lange FJ, de Jong JSSG, Wieling W, van Dijk N, Tan HL. Syncope in Brugada syndrome: prevalence, clinical significance, and clues from history taking to distinguish arrhythmic from nonarrhythmic causes. Heart Rhythm 2014; 12:367-75. [PMID: 25311410 DOI: 10.1016/j.hrthm.2014.10.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Syncope in Brugada syndrome (BrS) patients is a sign of increased risk for sudden cardiac death and usually is ascribed to cardiac arrhythmias. However, syncope often occurs in the general population, mostly from nonarrhythmic causes (eg, reflex syncope). OBJECTIVE The purpose of this study was to distinguish arrhythmic events from nonarrhythmic syncope in BrS and to establish the clinical relevance of nonarrhythmic syncope. METHODS We reviewed the patient records of 342 consecutively included BrS patients and conducted systematic interviews in 141 patients with aborted cardiac arrest (ACA) or syncope. RESULTS In total, 23 patients (7%) experienced ECG-documented ACA and 118 (34%) syncope; of these 118, 67 (57%) were diagnosed with suspected nonarrhythmic syncope. Compared to suspected nonarrhythmic syncope patients, ACA patients were older at first event (45 vs 20 years), were more likely to be male (relative risk 2.1) and to have urinary incontinence (relative risk 4.6), and were less likely to report prodromes. ACA was never triggered by hot/crowded surroundings, pain or other emotional stress, seeing blood, or prolonged standing. During follow-up (median 54 months), ACA rate was 8.7% per year among ACA patients and 0% per year among suspected nonarrhythmic syncope patients. CONCLUSION Syncope, especially nonarrhythmic syncope, often occurs in BrS. The high incidence of nonarrhythmic syncope must be taken into account during risk stratification. Arrhythmic events and nonarrhythmic syncope may be distinguished by clinical characteristics (absence of prodromes and, particularly, specific triggers), demonstrating the importance of systematic history taking.
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Affiliation(s)
| | - Arja S Vink
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Freek J de Lange
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Jonas S S G de Jong
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Wouter Wieling
- Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Nynke van Dijk
- Department of General Practice/Family Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
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Smolensky MH, Portaluppi F, Manfredini R, Hermida RC, Tiseo R, Sackett-Lundeen LL, Haus EL. Diurnal and twenty-four hour patterning of human diseases: cardiac, vascular, and respiratory diseases, conditions, and syndromes. Sleep Med Rev 2014; 21:3-11. [PMID: 25129838 DOI: 10.1016/j.smrv.2014.07.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 07/04/2014] [Indexed: 11/25/2022]
Abstract
Various medical conditions, disorders, and syndromes exhibit predictable-in-time diurnal and 24 h patterning in the signs, symptoms, and grave nonfatal and fatal events, e.g., respiratory ones of viral and allergic rhinorrhea, reversible (asthma) and non-reversible (bronchitis and emphysema) chronic obstructive pulmonary disease, cystic fibrosis, high altitude pulmonary edema, and decompression sickness; cardiac ones of atrial premature beats and tachycardia, paroxysmal atrial fibrillation, 3rd degree atrial-ventricular block, paroxysmal supraventricular tachycardia, ventricular premature beats, ventricular tachyarrhythmia, symptomatic and non-symptomatic angina pectoris, Prinzmetal vasospastic variant angina, acute (non-fatal and fatal) incidents of myocardial infarction, sudden cardiac arrest, in-bed sudden death syndrome of type-1 diabetes, acute cardiogenic pulmonary edema, and heart failure; vascular and circulatory system ones of hypertension, acute orthostatic postprandial, micturition, and defecation hypotension/syncope, intermittent claudication, venous insufficiency, standing occupation leg edema, arterial and venous branch occlusion of the eye, menopausal hot flash, sickle cell syndrome, abdominal, aortic, and thoracic dissections, pulmonary thromboembolism, and deep venous thrombosis, and cerebrovascular transient ischemic attack and hemorrhagic and ischemic stroke. Knowledge of these temporal patterns not only helps guide patient care but research of their underlying endogenous mechanisms, i.e., circadian and others, and external triggers plus informs the development and application of effective chronopreventive and chronotherapeutic strategies.
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Affiliation(s)
- Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, 1 University Station C0800, Austin, TX 78712-0238, USA.
| | - Francesco Portaluppi
- Hospital S. Anna and Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Roberto Manfredini
- Hospital S. Anna and Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ramon C Hermida
- Bioengineering & Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo, Spain
| | - Ruana Tiseo
- Hospital S. Anna and Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Linda L Sackett-Lundeen
- Department of Laboratory Medicine & Pathology, University of Minnesota, HealthPartners Institute for Education and Research and the Department of Pathology, Regions Hospital, St. Paul, MN, USA
| | - Erhard L Haus
- Department of Laboratory Medicine & Pathology, University of Minnesota, HealthPartners Institute for Education and Research and the Department of Pathology, Regions Hospital, St. Paul, MN, USA
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7
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Increased heart rate caused by atrial pacing with the closed-loop stimulation function prevented micturition syncope. J Arrhythm 2013. [DOI: 10.1016/j.joa.2013.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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So JH, Shin WJ, Byun JW, Yeom JH. Sudden syncopal attack after postobstructed diuresis under combined spinal epidural anesthesia. Korean J Anesthesiol 2013; 65:475-6. [PMID: 24363855 PMCID: PMC3866348 DOI: 10.4097/kjae.2013.65.5.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ji-Hyun So
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Woo-Jong Shin
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Jang-Won Byun
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Jong-Hun Yeom
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
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Son HW, Kim DY, Lee OK, Park SE, Cho YW. Severe hypotension following urethral catheterization during general anesthesia in a patient with bladder cancer -A case report-. Korean J Anesthesiol 2012; 62:91-5. [PMID: 22323962 PMCID: PMC3272537 DOI: 10.4097/kjae.2012.62.1.91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 06/29/2011] [Accepted: 07/11/2011] [Indexed: 11/10/2022] Open
Abstract
The process of micturition is related to activation of the cardiovascular autonomic nervous system. Hypotension with bradycardia often occurs during or immediately after micturition. We experienced a case of sudden severe hypotension and bradycardia following urethral catheterization in a patient who underwent an urethral dilatation and transurethral resection of bladder tumor while under general anesthesia. The patient was treated with inotropics and intravenous fluids, and he recovered without any complications. The characteristics of this case are similar to the physiologic changes that occur in micturition syncope. Therefore, it is presumed that the autonomic reflex that was triggered by the urethral catheterization caused the hypotension and bradycardia.
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Affiliation(s)
- Hee Won Son
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Korea
| | - Dae-Young Kim
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Korea
| | - Ok-Kyung Lee
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Korea
| | - Soon Eun Park
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Korea
| | - Young Woo Cho
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Korea
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BAE MYUNGH, KANG JUNGK, KIM NAY, CHOI WONS, KIM KYUNH, PARK SUNH, LEE JANGH, YANG DONGH, PARK HUNS, CHO YONGKEUN, CHAE SHUNGC, JUN JAEEUN. Clinical Characteristics of Defecation and Micturition Syncope Compared with Common Vasovagal Syncope. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 35:341-7. [DOI: 10.1111/j.1540-8159.2011.03290.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kohno R, Abe H, Akamatsu N, Oginosawa Y, Tamura M, Takeuchi M, Otsuji Y. Syncope and Ictal Asystole Caused by Temporal Lobe Epilepsy. Circ J 2011; 75:2508-10. [DOI: 10.1253/circj.cj-11-0261] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ritsuko Kohno
- Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health
| | - Naoki Akamatsu
- Department of Neurology, University of Occupational and Environmental Health
| | - Yasushi Oginosawa
- Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Masahito Tamura
- Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Masaaki Takeuchi
- Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health
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Lelonek M, Zelazowska M, Pietrucha T. Genetic Variation in Gs.ALPHA. Protein as a New Indicator in Screening Test for Vasovagal Syncope. Circ J 2011; 75:2182-6. [DOI: 10.1253/circj.cj-11-0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Komatsu K, Sumiyoshi M, Abe H, Kohno R, Hayashi H, Sekita G, Tokano T, Nakazato Y, Daida H. Clinical Characteristics of Defecation Syncope Compared With Micturition Syncope. Circ J 2010; 74:307-11. [DOI: 10.1253/circj.cj-09-0421] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kaoru Komatsu
- Department of Cardiology, Juntendo University School of Medicine
| | | | - Haruhiko Abe
- Department of Cardiology, University of Occupational and Environmental Health
| | - Ritsuko Kohno
- Department of Cardiology, University of Occupational and Environmental Health
| | - Hidemori Hayashi
- Department of Cardiology, Juntendo University School of Medicine
| | - Gaku Sekita
- Department of Cardiology, Juntendo University School of Medicine
| | - Takashi Tokano
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Yuji Nakazato
- Department of Cardiology, Juntendo University Urayasu Hospital
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University School of Medicine
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