Syncope in hypertrophic cardiomyopathy (part II): An expert consensus statement on the diagnosis and management

Brignole, Michele; Cecchi, Francesca; Anastasakis, Aris; Crotti, Lia; Deharo, Jean Claude; Elliott, Perry M.; Fedorowski, Artur; Kaski, Juan Pablo; Limongelli, Giuseppe; Maron, Martin S.; Olivotto, Iacopo; Ommen, Steve R.; Parati, Gianfranco; Shen, Win Kuang; Ungar, Andrea; Wilde, Arthur A.M.

doi:10.1016/j.ijcard.2022.10.153

Cited by 14 publications

(5 citation statements)

References 19 publications

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“… 22 , 35 Moreover, the diagnosis of arrhythmic syncope mostly relies on patients’ memory and their ability to describe the event. 36 , 37 This complexity is compounded by the fact that syncope is a frequent symptom: 30% of BrS patients will have experienced syncope at the time of diagnosis. The high prevalence of syncope, particularly vasovagal syncope, suggests that a patient with BrS may experience episodes of both vasovagal and arrhythmic syncopes.…”

Section: Discussionmentioning

confidence: 99%

Implantable loop recorders in patients with Brugada syndrome: the BruLoop study

Bergonti,

Sacher,

Arbelo

et al. 2024

European Heart Journal

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Background and Aims Available data on continuous rhythm monitoring by implantable loop recorders (ILRs) in patients with Brugada syndrome (BrS) are scarce. The aim of this multi-centre study was to evaluate the diagnostic yield and clinical implication of a continuous rhythm monitoring strategy by ILRs in a large cohort of BrS patients and to assess the precise arrhythmic cause of syncopal episodes. Methods A total of 370 patients with BrS and ILRs (mean age 43.5 ± 15.9, 33.8% female, 74.1% symptomatic) from 18 international centers were included. Patients were followed with continuous rhythm monitoring for a median follow-up of 3 years. Results During follow-up, an arrhythmic event was recorded in 30.7% of symptomatic patients [18.6% atrial arrhythmias (AAs), 10.2% bradyarrhythmias (BAs), and 7.3% ventricular arrhythmias (VAs)]. In patients with recurrent syncope, the aetiology was arrhythmic in 22.4% (59.3% BAs, 25.0% VAs, and 15.6% AAs). The ILR led to drug therapy initiation in 11.4%, ablation procedure in 10.9%, implantation of a pacemaker in 2.5%, and a cardioverter-defibrillator in 8%. At multivariate analysis, the presence of symptoms [hazard ratio (HR) 2.5, P = .001] and age >50 years (HR 1.7, P = .016) were independent predictors of arrhythmic events, while inducibility of ventricular fibrillation at the electrophysiological study (HR 9.0, P < .001) was a predictor of VAs. Conclusions ILR detects arrhythmic events in nearly 30% of symptomatic BrS patients, leading to appropriate therapy in 70% of them. The most commonly detected arrhythmias are AAs and BAs, while VAs are detected only in 7% of cases. Symptom status can be used to guide ILR implantation.

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Section: Discussionmentioning

confidence: 99%

Implantable loop recorders in patients with Brugada syndrome: the BruLoop study

Bergonti,

Sacher,

Arbelo

et al. 2024

European Heart Journal

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“…Patients with unexplained syncope should be tested with at least 24-hr Holter recording and exercise time-to-exhaustion to rule out LVOT obstruction on exertion. After an extensive evaluation of causes of syncope in those patients without clear diagnosis, an ILR should be implanted[ 1 , 117 ]. Routine tilt table testing in patients with HCM may be associated with an unacceptable number of false positives, and its use should be limited to selected cases[ 117 ].…”

Section: Arrhythmic Syncope In Specific Populationsmentioning

confidence: 99%

“…After an extensive evaluation of causes of syncope in those patients without clear diagnosis, an ILR should be implanted[ 1 , 117 ]. Routine tilt table testing in patients with HCM may be associated with an unacceptable number of false positives, and its use should be limited to selected cases[ 117 ].…”

Section: Arrhythmic Syncope In Specific Populationsmentioning

confidence: 99%

“…Patients with intermediate-risk and low-risk clinical profiles should be evaluated for additional risk factors not included in the score, following 2022 ESC guidelines[ 19 ]. LV systolic dysfunction, apical aneurysm, > 15% of LV mass with late gadolinium enhancement on CMR, and several sarcomeric mutations have demonstrated a higher risk of ventricular arrhythmias in different studies and should be considered when evaluating the risk profile of a given patient[ 117 , 118 ]. The risk of ventricular arrhythmias is nonetheless dynamic and needs to be reassessed at every clinical visit.…”

Section: Arrhythmic Syncope In Specific Populationsmentioning

confidence: 99%

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Arrhythmic syncope: From diagnosis to management

Pascual¹,

Marchite²,

Silva³

et al. 2023

World J Cardiol

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Syncope is a concerning symptom that affects a large proportion of patients. It can be related to a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death. However, benign causes are the most frequent, and identifying high-risk patients with potentially severe etiologies is crucial to establish an accurate diagnosis, initiate effective therapy, and alter the prognosis. The term cardiac syncope refers to those episodes where the cause of the cerebral hypoperfusion is directly related to a cardiac disorder, while arrhythmic syncope is cardiac syncope specifically due to rhythm disorders. Indeed, arrhythmias are the most common cause of cardiac syncope. Both bradyarrhythmia and tachyarrhythmia can cause a sudden decrease in cardiac output and produce syncope. In this review, we summarized the main guidelines in the management of patients with syncope of presumed arrhythmic origin. Therefore, we presented a thorough approach to syncope work-up through different tests depending on the clinical characteristics of the patients, risk stratification, and the management of syncope in different scenarios such as structural heart disease and channelopathies.

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“…For example, approximately 15–60% of patients with HCM reported at least one syncope or presyncope episode [ 13 ]. Some complex mechanisms trigger the development of this condition, such as aggravating LV outflow tract (OT) obstruction, ventricular baroreflex activation with inappropriate vasodilatation, and myocardial ischemia [ 14 ]. During or immediately after peak exercise, systemic vascular resistance failed to increase or paradoxically decreased in HCM, whereas it increased in normal controls [ 15 ].…”

Section: Concerns About Exercise In Hcm Patientsmentioning

confidence: 99%

Exercise in Hypertrophic Cardiomyopathy: Recent Conceptual Changes and Recommendations for Pre-Exercise Tests

Seo¹,

Choi²,

Rim³

2023

Rev. Cardiovasc. Med.

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Traditionally, individuals with hypertrophic cardiomyopathy (HCM) have been advised not to participate in more than low-intensity exercises. HCM was originally described in the context of sudden death, and early literature from the registry showed that HCM was the most common cause of sudden cardiac death in young athletes. Therefore, there has long been a concern that exercise could trigger ventricular arrhythmia and sudden cardiac death. Although a few patients with HCM may progress along deteriorating disease pathways, many have no clinically significant symptoms or adverse events, no need for major treatment, and a normal life expectancy. Therefore, the routine restriction of any exercise intensity in this large group deprives them of the multiple benefits of exercise and may have detrimental effects on long-term clinical outcomes. However, it has been reported that light to moderate exercise is acceptable for many patients with HCM, and recent evidence suggests that vigorous exercise does not increase the risk of sudden death in this population. Thus, we reviewed previous literature regarding the effects of exercise in patients with HCM and provided cutting-edge information on the safety and concerns of exercise. In addition, based on our experience and previous research, we reviewed the conditions that should be met before starting exercise and the tests required to confirm them.

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Syncope in hypertrophic cardiomyopathy (part II): An expert consensus statement on the diagnosis and management

Cited by 14 publications

References 19 publications

Implantable loop recorders in patients with Brugada syndrome: the BruLoop study

Implantable loop recorders in patients with Brugada syndrome: the BruLoop study

Arrhythmic syncope: From diagnosis to management

Exercise in Hypertrophic Cardiomyopathy: Recent Conceptual Changes and Recommendations for Pre-Exercise Tests

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