Malignant vasovagal syncope: prolonged asystole provoked by head-up tilt: Case report and review of diagnosis, pathophysiology, and therapy

Abstract

is a common clinical disorder that often escapes diagnosis; if the syncope is recurrent and severe (malignant vasovagal syncope), it can be a source of morbidity and possibly mortality. The authors report a 39-year-old patient with recurrent, unexplained syncope who underwent provocative head-up tilt testing that resulted in asystole for 73 seconds. In addition to vasovagal syncope, head-up tilt test also aids in the diagnosis and management of disorders of blood pressure and heart rate regulation. Management of recurrent vasovagal syncope is based upon the underlying pathophysiology and includes transdermal scopolamine, volume expansion, biofeedback, support stockings, and pacemakers (preferably AV sequential).

A profound case of neurally mediated syncope with asystole after septoplasty

“…Asystole is associated with syncopal events 50% of the time [4] and may be especially concerning in the perioperative setting; however, no specific definition (eg, duration) of asystole exists [8]. Studies using the controlled environment of tilt table testing have shown that the length of asystole associated with syncope varies from three to 34 seconds [9][10][11][12][13][14][15][16]. However, despite considerable study of VVS, its pathophysiology remains to be fully elucidated [1].…”

Tilt-induced cardioinhibitory syncope: a follow-up study in 16 patients

“…It may occur at any age and accounts for more than one-third of all causes of syncope [1]. Vasovagal syncope is generally considered a benign condition that does not represent a threat to life or significantly impair quality of life [2], although, occasionally, very prolonged ventricular asystole lasting up to 73 s may occur during vasovagal syncope [3]. In tilt-table studies, asystole of over 3-5 s occurs in 15% of patients, with a range from 4 to 33%.…”

Teste de inclinação (Tilt-test): do necessário ao imprescindível

“…There have been reports of asystole of 73 seconds, which was reversed with resuscitation and atropine, without any sequelae after the examination 36 . The pauses usually last less than 30 seconds, but longer pauses are not considered major complications.…”