Pacing for Vasovagal Syncope

Gopinathannair, Rakesh; Salgado, Benjamin C.; Olshansky, Brian

doi:10.15420/aer.2018.22.2

Cited by 30 publications

(16 citation statements)

References 74 publications

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“…Hypotensive susceptibility is suspected to exist in most people, particularly in individuals with a history of syncope 3 . Its identification is thought to play a key role in the management of syncope and selection of effective therapy, such as guiding pacemaker therapy in reflex syncope 14 , as well as to be the reason for the good response to pacing in tilt-negative patients 5 . In writing of the European Society of Cardiology Guidelines on Syncope 2018, the concept of hypotensive susceptibility was further extended to anticipate that some patients with reflex syncope were constitutionally predisposed to reflex syncope based on presenting a low blood pressure—‘a low blood pressure phenotype’ 9 .…”

Section: Discussionmentioning

confidence: 99%

Underlying hemodynamic differences are associated with responses to tilt testing

Fedorowski

Rivasi

Torabi

et al. 2021

Sci Rep

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Aim of this study was to explore whether differences in resting hemodynamic parameters may be associated with tilt test results in unexplained syncope. We analyzed age, gender, systolic (SBP), diastolic blood pressure (DBP) and heart rate (HR) by merging three large databases of patients considered likely to be of vasovagal reflex etiology, comparing patients who had tilt-induced reflex response with those who did not. Tilt-induced reflex response was defined as spontaneous symptom reproduction with characteristic hypotension and bradycardia. Relationship of demographics and baseline supine BP to tilt-test were assessed using logistic regression models. Individual records of 5236 patients (45% males; mean age: 60 ± 22 years; 32% prescribed antihypertensive therapy) were analyzed. Tilt-positive (n = 3129, 60%) vs tilt-negative patients had lower SBP (127.2 ± 17.9 vs 129.7 ± 18.0 mmHg, p < 0.001), DBP (76.2 ± 11.5 vs 77.7 ± 11.7 mmHg, p < 0.001) and HR (68.0 ± 11.5 vs 70.5 ± 12.5 bpm, p < 0.001). In multivariable analyses, tilt-test positivity was independently associated with younger age (Odds ratio (OR) per 10 years:1.04; 95% confidence interval (CI), 1.01–1.07, p = 0.014), SBP ≤ 128 mmHg (OR:1.27; 95%CI, 1.11–1.44, p < 0.001), HR ≤ 69 bpm (OR:1.32; 95%CI, 1.17–1.50, p < 0.001), and absence of hypertension (OR:1.58; 95%CI, 1.38–1.81, p < 0.001). In conclusion, among patients with suspected reflex syncope, younger age, lower blood pressure and lower heart rate are associated with positive tilt-test result.

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Section: Discussionmentioning

confidence: 99%

Underlying hemodynamic differences are associated with responses to tilt testing

Fedorowski

Rivasi

Torabi

et al. 2021

Sci Rep

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“…Temporal sequence of events in NMS with asystole may show the ideal candidate for CLS pacing: patients in whom asystole occurs before syncope, with BP being normal or mildly decreased in this phase [ 29 ]. Video recording and electroencephalographic monitoring in TTT can help identifying these patients, considering asystole as the main mechanism when asystole and syncope occur in close proximity of each other [ 30 , 31 ].…”

Section: The Importance Of the Cardioinhibitory Reflex For Patient Selection For Pacemaker Implantationmentioning

confidence: 99%

Electrocardiographic Patterns in Patients with Neurally Mediated Syncope

et al. 2021

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The baseline electrocardiogram (ECG) is less informative in neurally mediated syncope (NMS) than in arrhythmic syncope. However, some of the ECG patterns present in NMS can have diagnostic and prognostic value in such patients. Electrocardiographic documentation of a syncopal spell and thus identification of the ECG changes can be performed during tilt table test (TTT) or during prolonged ECG monitoring. This work reviews the specific ECG patterns in NMS, which are primarily related to the cardioinhibitory reflex. In addition, there are other ECG findings present in patients with NMS that are being analyzed, such as increased heart rate variability as well as specific QRS voltage patterns. In addition to the diagnostic and prognostic value, these ECG patterns in NMS may help improving the selection of patients for pacemaker implant.

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“…In patients with vasovagal syncope, it is due to a common autonomic reflex involving the cardiovascular system. It is associated with bradycardia (cardioinhibitory response) and/or hypotension (vasodepressor response), likely mediated by parasympathetic activation and sympathetic inhibition [16]. In these patients, the sitting position should be with the legs along the operating table.…”

Section: Sitting Positionmentioning

confidence: 99%

Spinal Anesthesia: Much More Than Single Shot of Hyperbaric Bupivacaine

Eduardo¹,

A²,

Maluf³

et al. 2021

Int J Anesthetic Anesthesiol

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There is significant and renewed attentiveness in the use of regional anesthesia techniques for many common surgeries. The vast majority of anesthesiologists world wide use the routinely the hyperbaric solution of bupivacaine for almost all types of surgery. However, they ignore that spinal anesthesia has more to offer. A different kind of technique for a different kind of patients. The understanding of spinal anesthesia in relation to sensory and motor blocks with hyperbaric and isobaric solutions is shown in this article. The possibilities of performing unilateral spinal anesthesia are described. The use of posterior spinal anesthesia shows that it is possible to perform only sensitive spinal anesthesia without motor block.The possibility of using isobaric and hypobaric solutions for different types of surgery has increased considerably. Thoracic spinal anesthesia has been shown feasible and safe for different types of surgeries, and more recently, thoracic continuous spinal anesthesia is being used. This article shows the possibility of performing spinal anesthesia for laparoscopic surgery, thoracic spinal anesthesia, segmental spinal anesthesia and continuous techniques.

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Pacing for Vasovagal Syncope

Cited by 30 publications

References 74 publications

Underlying hemodynamic differences are associated with responses to tilt testing

Underlying hemodynamic differences are associated with responses to tilt testing

Electrocardiographic Patterns in Patients with Neurally Mediated Syncope

Spinal Anesthesia: Much More Than Single Shot of Hyperbaric Bupivacaine

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