Diagnostic and prognostic implicatioins of recurrences in patients with syncope

Kapoor, Wishwa N.; Peterson, Jacqueline; Wieand, Harry S.; Karpf, Michael

doi:10.1016/0002-9343(87)90901-6

Cited by 122 publications

(56 citation statements)

References 42 publications

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“…[1][2][3][4][5] A similar recurrence rate, between 30% and 40% after 1 year, has frequently been observed in patients with a history of recurrent syncope. [2][3][4][5][6] In the patients of both groups who had a documented recurrence, the most frequent finding was bradycardia at the time of the episode; typically, these patients had progressive sinus bradycardia that was most often followed by ventricular asystole due to sinus arrest or progressive tachycardia followed by progressive bradycardia and ventricular asystole due to sinus arrest; very long asystolic pauses were recorded at the time of syncope in most cases. These findings strongly suggest that, in both groups, the syncope was probably neurally-mediated and that the most frequent mechanism is a dominant cardioinhibitory reflex with prolonged asystolic pauses.…”

Section: Discussionmentioning

confidence: 99%

Mechanism of Syncope in Patients With Isolated Syncope and in Patients With Tilt-Positive Syncope

et al. 2001

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on behalf of the International Study on Syncope of Uncertain Etiology (ISSUE) Investigators* Background-Because of its episodic behavior, the correlation of spontaneous syncope with an abnormal finding can be considered a reference standard. Methods and Results-We inserted an implantable loop recorder in 111 patients with syncope, absence of significant structural heart disease, and a normal ECG; tilt-testing was negative in 82 (isolated syncope) and positive in 29 (tilt-positive). The patients had had Ն3 episodes of syncope in the previous 2 years and were followed up for 3 to 15 months. Results were similar in the isolated syncope group and the tilt-positive group: syncope recurred in 28 (34%) and 10 patients (34%), respectively, and electrocardiographic correlation was found in 24 (23%) and 8 (28%) patients, respectively. The most frequent finding, which was recorded in 46% and 62% of patients, respectively, was one or more prolonged asystolic pauses, mainly due to sinus arrest, preceded for a few minutes by progressive bradycardia or progressive tachycardia-bradycardia. Bradycardia without pauses was observed in 8% and 12% of cases, respectively. The remaining patients had normal sinus rhythm or sinus tachycardia, except for one, who had ectopic atrial tachycardia.In the tilt-positive group, an asystolic syncope was also recorded when the type of response to tilt-testing was vasodepressor or mixed. Presyncopal episodes were never characterized by asystolic pauses; normal sinus rhythm was the most frequent finding. Conclusions-Homogeneous findings were observed during syncope. In most patients, the likely cause was neurallymediated, and the most frequent mechanism was a bradycardic reflex. In the other cases, a normal sinus rhythm was frequently recorded. Presyncope was not an accurate surrogate for syncope in establishing a diagnosis. (Circulation.

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Section: Discussionmentioning

confidence: 99%

Mechanism of Syncope in Patients With Isolated Syncope and in Patients With Tilt-Positive Syncope

et al. 2001

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“…Approximately 35% of patients have recurrences of syncope at 3 years of follow-up; 82% of recurrences occur within the first 2 years [28,38] . Predictors of recurrence of syncope include having had recurrent syncope at the time of presentation (four or more episodes in one study [38] ) or a psychiatric diagnosis [38][39][40] .…”

Section: Recurrencesmentioning

confidence: 99%

Guidelines on management (diagnosis and treatment) of syncope

Brignole¹,

Alboni²,

Benditt

et al. 2001

European Heart Journal

680

432

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“…In general, the majority of patients benefi t from general dietetic and behavioral measures, however, pharmacological intervention is required in a specifi c subgroup in whom symptoms are not adequately controlled 25,26 . Kapoor et al [25][26][27] , observed that accidents were reported in 6% of the patients with NMS, with the smaller injury being laceration. Contusions occurred in 29% of the cases.…”

Section: Discussionmentioning

confidence: 99%

“…The frequency and number of syncope episodes previously to the diagnosis are described as independent risk factors 25,26,30,31 .…”

Section: Discussionmentioning

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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Diagnostic and prognostic implicatioins of recurrences in patients with syncope

Cited by 122 publications

References 42 publications

Mechanism of Syncope in Patients With Isolated Syncope and in Patients With Tilt-Positive Syncope

Mechanism of Syncope in Patients With Isolated Syncope and in Patients With Tilt-Positive Syncope

Guidelines on management (diagnosis and treatment) of syncope

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

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