Prognostic Value of a Very Prolonged Asystole during Head‐Up Tilt Test

Carvalho, Maria Salomé; Santos, Katya Reis; Carmo, Pedro; Cavaco, Diogo; Parreira, Leonor; Morgado, Francisco; Adragão, Pedro

doi:10.1111/pace.12656

Cited by 18 publications

(10 citation statements)

References 28 publications

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“…Regarding the clinical profile of the case series of the present study, 9.2% of the patients submitted to TT had cardioinhibitory response, an incidence in accordance to those in the literature: up to 6.6%, considering only the passive phase, 28 or up to 21% in sensitized protocols. 7-9 Trauma secondary to syncope occurred in 20% of the case group with exclusively vasovagal syncope, while in the literature that ranged from 27.5% to 29% in a heterogeneous group (vasovagal and of unexplained origin).…”

Section: Discussionsupporting

confidence: 89%

Analysis of Heart Rate Variability Before and During Tilt Test in Patients with Cardioinhibitory Vasovagal Syncope

Miranda¹,

Silva²

2016

Arquivos Brasileiros De Cardiologia

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BackgroundCardioinhibitory vasovagal response is uncommon during the tilt test (TT). Heart rate variability (HRV) by use of spectral analysis can distinguish patients with that response.ObjectiveTo compare the HRV in patients with cardioinhibitory vasovagal syncope (case group - G1) with that in patients without syncope and with negative response to TT (control group - G2).Methods64 patients were evaluated (mean age, 36.2 years; 35 men) and submitted to TT at 70 degrees, under digital Holter monitoring. The groups were paired for age and sex (G1, 40 patients; G2, 24).ResultsIn G1, 21 patients had a type 2A response and 19 had type 2B, with mean TT duration of 20.4 minutes. There was a greater low frequency (LF) component (11,6 versus 4,5 ms2, p=0.001) and a lower low/high frequency ratio in the supine position (3,9 versus 4,5 ms2, p=0.008) in G1, with no difference during TT between the groups. Applying the receiver operating characteristic curve for cardioinhibitory response, the area under the curve was 0.74 for the LF component in the supine position (p = 0.001). The following were observed for the cutoff point of 0.35 ms(2) for the LF component: sensitivity, 97.4%; specificity, 83.3%; positive predictive value, 85.3%; negative predictive value, 96.9%; and positive likelihood ratio, 5.8.ConclusionHRV in the supine position allowed identifying patients with syncope and cardioinhibitory response with a high negative predictive value and likelihood ratio of 5.8.

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Section: Discussionsupporting

confidence: 89%

Analysis of Heart Rate Variability Before and During Tilt Test in Patients with Cardioinhibitory Vasovagal Syncope

Miranda¹,

Silva²

2016

Arquivos Brasileiros De Cardiologia

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“…The mean asystole duration in our cohort, with or without seizure, was similar to that reported previously for asystole followed by seizure (12.8 s) (23). Some studies have shown that the average age (range 21-47 years) for syncope without asystole is higher than syncope with asystole (15-32 years) (23)(24)(25)(26). Our data does not corroborate this relationship of complex VVS with age, though male gender increases the predisposition to complex syncope, that is, SySz.…”

Section: Discussionsupporting

confidence: 85%

“Complex” Vasovagal Syncope: A Zebra Among Horses

2020

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Background: Vasovagal syncope (VVS) occurs due to cerebral hypoperfusion from a fall in blood pressure, with accompanying bradycardia in most cases. Seizure and/or asystole may accompany VVS, though their prediction within the VVS cohort remains elusive.Objective: To further characterize VVS and to find predictive features of “complex” VVS (defined as VVS associated with seizures and/or asystole).Methods: We reviewed medical records of all patients who were referred for orthostatic intolerance and had a definite VVS during the head-up tilt table testing (HUTT). The following variables were recorded: cardiovascular indices during HUTT, autonomic testing results, and semiology of asystole and/or seizure when present. Simple frequency and correlation analysis were performed using the ANOVA.Results: A total of 78 independent VVS were recorded in 60 patients of which 24% were not preceded by presyncope. Vasodepressor (45%) and mixed (38%) VVS were the most prevalent types. Eighteen (23%) were complex VVS; five had an associated seizure (SySz), nine were accompanied by asystole (SyAs), and four had both (SySzAs). Males were significantly more likely to have complex VVS. Mean asystole duration was somewhat longer in the SyAsSz group. The severity of bradycardia significantly correlated with complex VVS and was a predictor of SySz. Autonomic abnormalities were frequent but did not distinguish the two VVS subgroups. Seizures had multiple distinguishing features from those typically associated with epileptic seizures.Conclusions: The underlying pathophysiologic mechanisms of complex VVS remain unclear, but the severity of cerebral hypoperfusion due to bradycardia likely plays a key role in seizure generation.

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“…The second alignment was performed based on asystole duration. The cutoff value was 30 s according to cardiac electrophysiology literature, where vagally induced asystole >30 s was labeled “very prolonged” and “malignant.” We aimed to test whether the presence of a “very prolonged” IA (>30 s) was characteristic for different or more severe seizures.…”

Section: Methodsmentioning

confidence: 99%

Ictal asystole: A systematic review

et al. 2016

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Characteristics considered to be typical of IA (focal, left temporal seizures appearing on grounds of a long-lasting, intractable epilepsy) seem only partially legitimate. We suggest that in new-onset IA, female gender and a preexisting heart condition could serve as predispositions in an otherwise benign epilepsy. We speculate that in late-onset IA, male-predominant changes in neuronal networks in chronic, intractable epilepsy and an accompanying autonomic dysregulation serve as facilitating factors.

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Prognostic Value of a Very Prolonged Asystole during Head‐Up Tilt Test

Cited by 18 publications

References 28 publications

Analysis of Heart Rate Variability Before and During Tilt Test in Patients with Cardioinhibitory Vasovagal Syncope

Analysis of Heart Rate Variability Before and During Tilt Test in Patients with Cardioinhibitory Vasovagal Syncope

“Complex” Vasovagal Syncope: A Zebra Among Horses

Ictal asystole: A systematic review

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