Current Evaluation and Management of Syncope

Kapoor, Wishwa N.

doi:10.1161/01.cir.0000031168.96232.ba

Cited by 124 publications

(110 citation statements)

References 39 publications

(31 reference statements)

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“…investigators agree that at least 40 % of patients with "unexplained" syncope have reflex (vasovagal) syncope [30,31]. Patients diagnosed with vasovagal syncope had the highest survival equal to those who had not suffered syncope.…”

Section: ■ Framingham Studiesmentioning

confidence: 98%

Epidemiology of reflex syncope

Colman

Nahm

Ganzeboom³

et al. 2004

Clin Auton Res

235

159

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Section: ■ Framingham Studiesmentioning

confidence: 98%

Epidemiology of reflex syncope

Colman

Nahm

Ganzeboom³

et al. 2004

Clin Auton Res

235

159

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“…It has not been reported a higher cardiovascular risk in that group of patients when compared to the normal population 3,4 . Diagnosis is reached by suggestive history, by the nondemonstration of arrhythmic causes and by positive TTT.…”

Section: Discussionmentioning

confidence: 58%

Síncope em pacientes com extra-sístoles de via de saída de ventrículo direito e sem cardiopatia estrutural aparente

Ludovice¹,

Hachul²,

Darrieux³

et al. 2006

Arq. Bras. Cardiol.

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objective: Study the prevalence of neurocardiogenic etiology in patients with unexplained syncope and ventricular premature beats, with right ventricle outflow tract morphology (RVOT) and no apparent structural cardiopathy. Methods:Ninety patients (66 women, mean age 40.2±16.95 years of age) with monomorphic premature beats originated at RVOT were evaluated prospectively. Fifty-four (54) patients reported syncopes or near-syncopes associated to palpitations or not; twenty-seven (27) presented palpitations with no pre-syncope or syncope, and nine (9) were asymptomatic. All patients were submitted to echocardiogram, high resolution ECG and cardiac MRI to rule out structural cardiopathy, to exertion test to rule out adrenergic dependent ventricular tachycardia, and ECG prolonged outpatient monitoring (Holter and symptomatic events monitor) to correlate symptoms and ventricular arrhythmias. Investigation on the susceptibility to neurocardiogenic syncope was evaluated by Tilt Table Test (TTT). Groups were compared regarding gender, age, premature beats frequency and complexity, at exertion or not, TTT results and clinical course. Results:In the syncope and pre-syncope groups, TTT was positive for 38% of cases, and in groups with palpitations and assymptomatics, it was positive for 11% (p = 0.0257). After recommendations and treatment of neurocardiogenic syncope, 85% of syncope and pre-syncope patients and positive TTT was asymptomatic along the 40-month follow-up. Two patients with syncope and negative TTT presented spontaneous, sustained ventricular tachycardia during clinic course. Conclusion:The prevalence of neurocardiogenic syncope in patients with idiopathic RVOT premature beats is high. Patients with recurrent, unexplained syncope and idiopathic VE must be kept under investigation. VPBs with right ventricle outflow tract morphology (RVOT) at ECG are frequently seen. Those patients may present recurring near-syncopes and syncopes, and most times it is not possible to establish a correlation between rhythm changes and the symptoms during outpatient ECG monitoring.Recurrent syncope is an alarming symptom. Syncope etiology is many times erroneously associated to that arrhythmia in individuals irrespective of the clinical correlation between symptoms and electrocardiographic findings.The neurocardiogenic syncope is the most common syncope etiology in individuals without apparent cardiopathy. It has not been reported a higher cardiovascular risk in that group of patients when compared to the normal population 3,4 . Diagnosis is reached by suggestive history, by the nondemonstration of arrhythmic causes and by positive TTT.The purpose of this study was to investigate the prevalence of neurocardiogenic syncope in patients with idiopathic RVOT premature beats. MethodsNinety patients were investigated prospectively: mean age 40.2 ± 16.95 (ranging between 7 and 79 years of age), being 66 of them females. Inclusion criteria included: the presence of idiopathic RVOT premature beats, characterized by left bundle branch bloc...

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“…Data of the Framingham's study 4 showed that the vasovagal or neurally mediated syncope (NMS) corresponds to 21.2% of all cases and is not related to increase in the cardiovascular risk, confi rming its benignity.…”

Section: Clinical Outcome Of Patients With Neurocardiogenic Syncope Amentioning

confidence: 99%

Evolução clínica de pacientes com síncope neurocardiogênica (SNC) após suspensão da terapia específica

Bastos¹,

Scanavacca

Darrieux

et al. 2006

Arq. Bras. Cardiol.

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OBJECTIVETo evaluate the outcome of patients with NCS after interruption of pharmacological therapy and to investigate the possible clinical variables predicting recurrence. METHODSThirty-seven patients (age 31±16 years) with refractory recurrent NCS being 19 females where prospectively studied. All patients became asymptomatic and had a negative tilt table test (TT) after pharmacological therapy. The treatment was interrupted and one month later, a new TT with no medication was carried out. The probability free of symptoms recurrence was analyzed according to sex, age, number of syncope episodes previously to the treatment, clinical history time, treatment time, drug free from treatment time and TT result. RESULTSTwenty-two patients (59%) presented recurrence during a mean follow-up of 21±19.7 months. The variables related to greater recurrence were number of previous syncope (p=0.0248), positive TT after interruption of the therapy (p=0.0002) and female gender (p= 0.0131). CONCLUSIONSMost of the very symptomatic patients with NCS present recurrence after the suppression of a specifi c therapy. A TT carried out after treatment discontinuation can identify patients with higher risk of recurrence, specially in the fi rst year of follow-up.

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Current Evaluation and Management of Syncope

Cited by 124 publications

References 39 publications

Epidemiology of reflex syncope

Epidemiology of reflex syncope

Síncope em pacientes com extra-sístoles de via de saída de ventrículo direito e sem cardiopatia estrutural aparente

Evolução clínica de pacientes com síncope neurocardiogênica (SNC) após suspensão da terapia específica

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