Analysis of Heart Rate Variability Before and During Tilt Test in Patients with
            Cardioinhibitory Vasovagal Syncope

Miranda, Cláudia Madeira; Silva, Rose Mary Ferreira Lisboa da

doi:10.5935/abc.20160177

Cited by 15 publications

(17 citation statements)

References 31 publications

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“…Phase 2 (Passive Tilt): the LF power of SBPV showed continuous decrement during this phase, which was different from the plateau pattern of LF power of HRV. Conflicting results about the LF power activity during the passive phase of HUTT has been reported, showing plateau responses, 25 increased activity, 26 and decreased activity. 27 Therefore the pattern of LF power activity in SBPV may be a correct response because it is not under the influence of other factors like baroreceptor sensitivity.…”

Section: Discussionmentioning

confidence: 90%

Simultaneous beat-to-beat heart rate and systolic blood pressure variability in patients with and without neurally mediated syncope

Akbarzadeh

Kazemi

2022

J Cardiovasc Thorac Res

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Introduction: Autonomic changes play an essential role in the genesis of neurally mediated syncope (NMS). The aim of this study was to compare the changes of the autonomic nervous system (ANS) by measuring spectral indices of beat-to-beat systolic blood pressure and heart rate variability (SBPV and HRV) in ranges of low frequency (LF), high frequency (HF), and the LF/HF ratio during head-up tilt test (HUTT) in patients with and without a syncope response. Methods: In this case-control study of 46 patients with a suspected history of unexplained syncope, data were recorded separately during the typical three phases of HUTT. Patients who developed syncope were designated as the case group and the rest as the control group. Results: Thirty one patients experienced syncope during HUTT. Resting HRV and SBPV indices were significantly lower in cases than controls. After tilting in the syncope group, both HF and LF powers of SBPV showed a significant and gradual decrease. LF/HF in HRV increased in both groups similarly during the test but in SBPV, mainly driven by oscilations in its LF power, it increased significantly more during the first two phases of the test in syncope patients only to paradoxically decrease during active tilt (P< 0.001). Conclusion: Our findings show an abnormal autonomic function in patients with syncope, both at rest and tilting. Fluctuations of spectral indices of beat-to-beat SBPV, a potential noval index of pure sympathetic activity, show an exaggerated response during tilt and its withdrawal before syncope.

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Section: Discussionmentioning

confidence: 90%

Simultaneous beat-to-beat heart rate and systolic blood pressure variability in patients with and without neurally mediated syncope

Akbarzadeh

Kazemi

2022

J Cardiovasc Thorac Res

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“…[ 19 , 20 ] Miranda et al reported that elevation in the LF/HF ratio and a decrease in HF were observed when the head was up during the TTT in patients with syncope. [ 21 ] Moreover, they reported that this phenomenon was more pronounced in these patients than in healthy subjects. The autonomic nerve balance in this case changed during the 10:00 to 12:00 period, which is a similar situation to what occurs during tilt-up in the TTT and might lead to syncope.…”

Section: Discussionmentioning

confidence: 95%

Frequent occurrence of postbreakfast syncope due to carotid sinus syndrome after surgery for hypopharyngeal cancer

et al. 2021

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Rationale: Syncope often occurs in patients with advanced head and neck cancers due to the stimulation of the autonomic nervous system by the tumor. Here, we describe a case of frequent syncopal episodes after laryngopharyngectomy for hypopharyngeal cancer. As all syncopal episodes were observed during the forenoon, we also evaluated the heart rate variability using ambulatory electrocardiography to determine why the syncopal episodes occurred during a specified period of the day. Patient concerns: A 73-year-old Japanese man who underwent laryngopharyngectomy for recurrent hypopharyngeal cancer started experiencing frequent episodes of loss of consciousness that occurred during the same time period (10:00–12:00). He had never experienced syncopal episodes before the operation. From 23 to 41 days postoperatively, he experienced 9 syncopal episodes that occurred regardless of his posture. Diagnoses: Pharyngo-esophagoscopy revealed an anastomotic stricture between the free jejunum graft and the upper esophagus. Swallowing videofluoroscopy confirmed the dilatation of the jejunal autograft and a foreign body stuck on the oral side of the anastomosis. Contrast-enhanced computed tomography revealed that the carotid artery was slightly compressed by the edematous free jejunum. The patient was diagnosed with carotid sinus syndrome (CSS) as the free jejunum was dilated when consuming breakfast, which may have caused carotid sinus hypersensitivity and induced a medullary reflex. Interventions: Administration of disopyramide was effective in preventing syncope. Heart rate variability analysis using ambulatory electrocardiography showed that parasympathetic dominancy shifted to sympathetic dominancy during 10:00 to 12:00. The significant time regularity of the syncopal episodes may have been affected by modified diurnal variation in autonomic tone activity. Outcomes: After the surgical release and re-anastomosis of the pharyngoesophageal stenosis via an open-neck approach, no recurrent episodes of syncope were reported. Lessons: We reported a case of frequent syncopal episodes limited to the forenoon due to CSS after surgery for hypopharyngeal carcinoma. The patient was treated with anticholinergics followed by the release and re-anastomosis of the pharyngoesophageal stenosis. When syncope occurs after surgery for head and neck lesions, CSS due to postoperative structural changes should be considered as a differential diagnosis of syncope.

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“…There have been attempts to use HRV analyses to predict the outcome of TTT and through this to improve the diagnosis of VVS, with variable degrees of success (Ciliberti et al, 2018;Klemenc and Štrumbelj, 2015;Miranda and Silva, 2016;Zheng et al, 2020).…”

Section: Heart Rate Variability In Vvsmentioning

confidence: 99%

The pathophysiology of vasovagal syncope: Novel insights

Dijk

Rossum

Thijs

2021

Autonomic Neuroscience

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Analysis of Heart Rate Variability Before and During Tilt Test in Patients with Cardioinhibitory Vasovagal Syncope

Cited by 15 publications

References 31 publications

Simultaneous beat-to-beat heart rate and systolic blood pressure variability in patients with and without neurally mediated syncope

Simultaneous beat-to-beat heart rate and systolic blood pressure variability in patients with and without neurally mediated syncope

Frequent occurrence of postbreakfast syncope due to carotid sinus syndrome after surgery for hypopharyngeal cancer

The pathophysiology of vasovagal syncope: Novel insights

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