Clinical significance and predisposing factors to symptomatic bradycardia and hypotension after percutaneous transluminal coronary angioplasty

Vaso-vagal reactions during femoral arterial sheath removal after percutaneous coronary intervention and impact on cardiac events

“…Major adverse cardiac events at day 30 occurred in 5.7% of patients experiencing vaso-vagal syncope and 7.1% of those who did not ( p = 1.00) with no case of stent thrombosis in the vaso-vagal group. Whilst unpleasant for patients, we conclude that vaso-vagal syncope during sheath removal after percutaneous coronary intervention is not associated with increased adverse cardiac events in the stent era.Vaso-vagal reactions are a relatively common complication of interventional coronary procedures with a reported incidence of between 3.4% and 13.9% [1][2][3]. The presence of pain, tissue injury and strong emotional states may contribute to the development of vaso-vagal syncope [4,5], which may have serious consequences (e.g., profound asystole or infarction) for patients after percutaneous coronary intervention (PCI) [2,5].…”

“…The presence of pain, tissue injury and strong emotional states may contribute to the development of vaso-vagal syncope [4,5], which may have serious consequences (e.g., profound asystole or infarction) for patients after percutaneous coronary intervention (PCI) [2,5]. Apart from infrequent case reports [2,5], there is little published literature on potential adverse cardiac events of vaso-vagal syncope during sheath removal particularly in the circumstance of recent stent deployment where profound hypotension and bradycardia may potentially lead to stent thrombosis.We previously reported [6] a randomized controlled trial, which assessed the impact of intravenous sedation and local anaesthesia during femoral sheath removal after PCI on patient comfort and the incidence of vaso-vagal reactions. The aim of the present study was to evaluate whether vasovagal syncope during sheath removal leads to a higher incidence of major adverse cardiac events including acute stent thrombosis.…”

“…Vaso-vagal reactions are a relatively common complication of interventional coronary procedures with a reported incidence of between 3.4% and 13.9% [1][2][3]. The presence of pain, tissue injury and strong emotional states may contribute to the development of vaso-vagal syncope [4,5], which may have serious consequences (e.g., profound asystole or infarction) for patients after percutaneous coronary intervention (PCI) [2,5].…”

“…The presence of pain, tissue injury and strong emotional states may contribute to the development of vaso-vagal syncope [4,5], which may have serious consequences (e.g., profound asystole or infarction) for patients after percutaneous coronary intervention (PCI) [2,5]. Apart from infrequent case reports [2,5], there is little published literature on potential adverse cardiac events of vaso-vagal syncope during sheath removal particularly in the circumstance of recent stent deployment where profound hypotension and bradycardia may potentially lead to stent thrombosis.…”

“…Vaso-vagal reactions are a well-recognised complication of interventional coronary procedures with a reported incidence of between 3.4% and 13.9% [1][2][3]7]. A few studies performed in the pre-stent era have reported the incidence of adverse cardiac events as a consequence of vaso-vagal syncope.…”