- Diagnostic and therapeutic approach to cardioinhibitory reflex syncope: A complex and controversial issue. [Review]Rev Port Cardiol 2019RP
- Syncope is defined as a transient loss of consciousness due to global cerebral hypoperfusion and is one of the leading causes of emergency department admission. The initial approach should focus on excluding non-syncopal causes for loss of consciousness and risk stratification for cardiac cause, in order to ensure an appropriate etiological investigation and therapeutic approach. Vasovagal syncop…
Syncope is defined as a transient loss of consciousness due to global cerebral hypoperfusion and is one of the leading causes of emergency department admission. The initial approach should focus on excluding non-syncopal causes for loss of consciousness and risk stratification for cardiac cause, in order to ensure an appropriate etiological investigation and therapeutic approach. Vasovagal syncope (VVS), the most common type of syncope, should be assumed once other causes are excluded. Pathophysiologically, the vasovagal reflex is the result of a paradoxical autonomic response, leading to hypotension and/or bradycardia. VVS has not been shown to affect mortality, but morbidity may be considerable in those with recurrent syncopal episodes. The management of VVS includes both non-pharmacological and pharmacological measures that act on various levels of the reflex arc that triggers the syncopal episode. However, most are of uncertain benefit given the scarcity of high-quality supporting evidence. Pacemaker therapy may be considered in recurrent refractory cardioinhibitory reflex syncope, for which it is currently considered a robust intervention, as noted in the European guidelines. Non-randomized and unblinded studies have shown a potential benefit of pacing in recurrent VVS, but double-blinded randomized controlled trials have not consistently demonstrated positive results. We performed a comprehensive review of the current literature and recent advances in cardiac pacing and pacing algorithms in VVS, and discuss the diagnostic and therapeutic approach to the complex patient with recurrent VVS and reduced quality of life.
- [Change in P wave on electrocardiogram and its diagnostic value in children and adolescents with cardioinhibitory vasovagal syncope]. [Journal Article]Zhongguo Dang Dai Er Ke Za Zhi 2019; 21(11):1084-1088ZD
- CONCLUSIONS: Children and adolescents with VVS-CI have significantly increased Pwd, Pmax, Pd, Pcmax, and Pcd, which may indicate abnormal atrial electrical activity. The cut-off value of P wave has a certain diagnostic value in VVS-CI.
- 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. [Journal Article]Europace 2019E
- CONCLUSIONS: 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.
- A systematic review on recurrent cardioinhibitory vasovagal syncope: Does pacing therapy break the fall? [Review]Pacing Clin Electrophysiol 2019; 42(10):1400-1407PC
- Vasovagal reflex is the most common cause of syncope. Pacemaker with rate drop response (RDR) or closed-loop stimulation (CLS) anti-syncope algorithms have been studied in recurrent vasovagal syncope (VVS), with conflicting results. We aim to investigate the role of pacemaker therapy and anti-syncope pacing mode in cardioinhibitory recurrent VVS. MEDLINE, Cochrane Library and registered clinical …
Vasovagal reflex is the most common cause of syncope. Pacemaker with rate drop response (RDR) or closed-loop stimulation (CLS) anti-syncope algorithms have been studied in recurrent vasovagal syncope (VVS), with conflicting results. We aim to investigate the role of pacemaker therapy and anti-syncope pacing mode in cardioinhibitory recurrent VVS. MEDLINE, Cochrane Library and registered clinical trials were searched for single or double-blind randomized controlled trials on pacing as a treatment for recurrent VVS. Five studies were eligible, overall enrolling 228 patients. After pooling data from all trials, pacemaker therapy showed a 63% reduction in syncope recurrence compared to control [Risk Ratio (RR): 0.37; 95% CI: 0.14-0.98; I2 = 67%)]. Subgroup analyses suggested that the effect was greater in single-blind studies (RR: 0.07; 95% CI: 0.01-0.52, I2 = 0%). When comparing pacing algorithms, the results from RDR versus no pacing trials (n = 2) did not show a significant reduction in syncope recurrence (RR: 0.73; 95% CI: 0.25-2.16, I2 60 = 75%). In contrast, the data from the CLS versus standard pacing trials (n = 3) evidenced a statistically meaningful reduction in syncopal burden (RR: 0.18; 95% CI: 0.07-0.47, I2 = 0%). It is unclear whether pacemaker therapy reduces syncopal burden in cardioinhibitory recurrent VVS. However, our results suggest effectiveness of CLS pacing mode.
- Aetiologies and temporal trends of atrioventricular block in young patients: a 20-year nationwide study. [Journal Article]Europace 2019; 21(11):1710-1716E
- CONCLUSIONS: In a nationwide cohort, the aetiology of AVB was identified in only half the patients younger than 50 years referred for first-time pacemaker implantation. The number of patients with unknown aetiology increased during the study period. These findings indicate need for better insight into aetiologies of AVB and improved diagnostic work-up guidelines.
- Does A Therapy for Reflex Vasovagal Syncope Really Exist? [Review]High Blood Press Cardiovasc Prev 2019; 26(4):273-281HB
- Syncope is a temporary loss of consciousness due to transient global cerebral hypoperfusion. Reflex syncope is the most frequent, representing 21% of all types of syncopal events, and includes: (a) the vasovagal syncope (classical type); (b) the situational syncope; (c) the carotid sinus syncope and (d) non-classical forms. An accurate anamnesis and physical examination are fundamental for the di…
Syncope is a temporary loss of consciousness due to transient global cerebral hypoperfusion. Reflex syncope is the most frequent, representing 21% of all types of syncopal events, and includes: (a) the vasovagal syncope (classical type); (b) the situational syncope; (c) the carotid sinus syncope and (d) non-classical forms. An accurate anamnesis and physical examination are fundamental for the diagnosis. Although limited evidence is available regarding the efficacy of some treatments, a number of these can be successfully used in the clinical practice. It is, however, important to personalize the therapeutic approach in order to achieve an efficient reduction or suppression of syncopal episodes. Patients should be reassured about the benignity of these events and the possibility of reducing their frequency over time. They should be also educated on how to recognize and abort incoming syncopal episodes. Patients may be advised to increase their introit in water and salt, as well as to reduce vasoactive medications, if no contraindications exist. Orthostatic training may be beneficial but only in very motivated young patients capable of strictly adhering to the exercise plan. So far, any proposed pharmacological treatment has demonstrated very limited efficacy and, therefore, it should be tried in case of failure of non-pharmacological approaches. Pacemaker implantation is clearly indicated in patients with documented cardioinhibitory syncope in the absence of a vasodepressor component, which can compromise their quality of life. Despite the American and European guidelines for the treatment of syncope are similar, still some differences can be denoted. Aim of this study is to evaluate the management of patients with recurrent syncopal episodes focusing on pharmacological and non-pharmacological approaches.
- Prevalence and One-year Outcome of Carotid Sinus Hypersensitivity in Unexplained Syncope: A Prospective Cohort Study from South India. [Journal Article]Indian Heart J 2019 Jan - Feb; 71(1):1-6IH
- CONCLUSIONS: In conclusion, the prevalence of CSH in patients above 50 yrs with unexplained syncope was high in our population. Patients with CSH and baseline symptoms developed recurrent syncope during follow up. Carotid sinus massage should be a part of routine examination protocol for unexplained syncope.
- The use of a single chamber leadless pacemaker for the treatment of cardioinhibitory vasovagal syncope. [Journal Article]Int J Cardiol Heart Vasc 2019; 23:100349IJ
- CONCLUSIONS: This observational study suggests that the use of a single chamber leadless pacemaker in the treatment of cardioinhibitory vasovagal syncope might be a reasonable clinical option.
- Inspiratory- and expiratory-gated transcutaneous vagus nerve stimulation have different effects on heart rate in healthy subjects: preliminary results. [Journal Article]Clin Auton Res 2019CA
- CONCLUSIONS: Expiratory-gated and non-respiratory-gated taVNS exert clear cardioinhibitory effects in healthy subjects with high pre-stimulatory HR, whereas inspiratory-gated taVNS does not affect HR. Cardiac and vascular effects of taVNS depend on pre-stimulatory HR.
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- The benefit of closed loop stimulation in patients with cardioinhibitory vasovagal syncope confirmed by head-up tilt table testing: a systematic review and meta-analysis. [Journal Article]J Interv Card Electrophysiol 2019; 55(1):105-113JI
- CONCLUSIONS: CLS pacing is beneficial for patients with recurrent vasovagal syncope who demonstrate a cardioinhibitory response on HUTT.