The relationship between health-related quality of life and frequency of spells in patients with syncope

Rose, Michael; Koshman, Mary Lou; Spreng, Sheila; Sheldon, Robert S.

doi:10.1016/s0895-4356(00)00257-2

Cited by 187 publications

(120 citation statements)

References 25 publications

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“…7 It is therefore likely that a patient who has experienced many attacks in the past will have recurrences after pacing, even if the clear indication for pacing was not reflex syncope. Further, if the indication for pacing is reflex syncope, recurrence is highly likely.…”

Section: Where We Are Nowmentioning

confidence: 99%

Syncope in Patients with Pacemakers

Sutton

2015

Arrhythmia &Amp; Electrophysiology Review

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Syncope in a patient with a pacemaker commands urgent action to ascertain its cause and provide appropriate treatment. This is a well accepted statement but the field has evolved in recent years and, strangely, has received little attention.Many considerations bear on this issue. First, syncope in pacemaker patients is not common but may be more so than generally considered.The lack of frequency may be attributed to better technology and greater expertise amongst practitioners but it should be modulated by the fact that more patients today receive pacemakers for other indications than syncope, rendering them unlikely to sustain syncope even if their pacemaker system fails. Second, we now live in an era of telemedicine where remote monitoring not only provides an opportunity to identify technological or arrhythmic causes of syncope in a pacemaker patient but also a chance for the patient very readily to report such an episode to hospital carers.1 Third, more patients today receive pacemakers for reflex syncope where the device is not expected to achieve the results in syncope prevention that pertain in atrioventricular block (AVB).2,3 Included with this aspect of syncope in pacemaker patients must also now be the realisation that syncope may be reflex in the largest group of patients worldwide that receive pacemakers, those with sino-atrial node disease. 4 It is in these contexts that a review of this serious clinical problem is due. Where We WereIn the late 1980s and early 1990s, we had already achieved a high standard of implant techniques and devices were well constructed with rare failure. and an additional patient with sensing failure, which was unlikely to have been the cause of syncope.3 Thus, 4.3 % had pacing failure as the cause of syncope, while at the same time 8.6 % had orthostatic hypotension and 36.9 % were tilt positive. These tilt findings were invoked as explaining the syncope sustained by these patients but no explanation was found in another 30.4 %. They concluded that reflex syncope may be the most common cause of recurrent syncope in paced patients, with pacing hardware failure being quite rare. This theme was reiterated by Sgarbossa et al. in a large series of 507 sick sinus syndrome patients from the Cleveland Clinic. 4 In 62 ± 38 months of follow-up, they found syncope recurrence in 3 % at 1 year, 8 % at 5 years and 13 % predicted at 10 years. Their analysis of the causes of syncope indicated lead or pacemaker failure in 6.5 %, vasovagal in 18 %, orthostatic hypotension in 25.5 %, unexplained in 29.5 %, atrial tachyarrhythmias in 11.5 % and ventricular tachyarrhythmias in 5 %. They concluded that autonomic disturbances were the main contributors to syncope recurrence and pacing hardware failure was uncommon. Such conclusion was reached at a time when syncope in sick sinus syndrome was considered to be sinus arrest without effective escape mechanism rather than reflex in origin. However, Sgarbossa et al. noted that syncope prior to implant was the only reliable predictor of syncope post-imp...

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Section: Where We Are Nowmentioning

confidence: 99%

Syncope in Patients with Pacemakers

Sutton

2015

Arrhythmia &Amp; Electrophysiology Review

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“…Functional impairment in recurrent neurocardiogenic syncope is thought to be similar to chronic illnesses such as rheumatoid arthritis, low back pain, and psychiatric disorders. 2,3) Various forms of medical treatment have been proposed for recurrent neurocardiogenic syncope. 4) In general, while the results of medical treatment have been satisfactory in uncontrolled trials or in short-term controlled trials, with few exceptions, several long-term placebo-controlled prospective trials have been unable to show a benefit of the active drug over placebo.…”

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confidence: 99%

Tilt Training for Recurrent Neurocardiogenic Syncope: Effectiveness, Patient Compliance, and Scheduling the Frequency of Training Sessions

et al. 2004

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SUMMARYUnsatisfactory results obtained with medical therapy and dual-chamber pacing for prevention of recurrent neurocardiogenic syncope necessitated the development of new treatment modalities. Tilt-training, a novel treatment for recurrent neurocardiogenic syncope based on exercise sessions with prolonged upright posture (either on a tilt-table or standing on foot against a wall), was shown to be effective in preventing the recurrence of neurocardiogenic syncope. The purpose of this study was to demonstrate the long-term beneficial effects of a transient tilt training program lasting 2 months.Thirty-two patients with recurrent neurocardiogenic syncope (mean number of syncope episodes in the last 6 months was 3.4 ± 2.3) constituted the study group. All of the patients were tilt test positive. The patients were taught a tilt training program with 2 phases (in-hospital training with repeated tilt procedures until 3 consecutive negative results were obtained and home exercises with standing against a wall) and home exercises lasted a maximum of 2 months. After this training program, the patients received no treatment and were followed for the recurrence of syncope. At the end of the follow-up period (376 ± 45 days), 81% of the patients were free of recurrent syncope.This study revealed that similar successful results can also be obtained with a transient tilt training program as a first line treatment strategy. Less interference with the daily activities of the patients is the major advantage of this strategy. The ease of performance and high effectiveness rate will most likely result in more frequent utilization of this treatment modality. (Jpn Heart J 2004; 45: 833-843) Key words: Recurrent neurocardiogenic syncope, Tilt training program RECURRENT neurocardiogenic syncope, which is defined as a sudden, transient loss of consciousness due to neurally-mediated hypotension and bradycarFrom the

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“…It is associated with reduced quality of life to a degree similar to that reported in chronic illnesses, and patients frequently suffer from anxiety, somatization, and depression (Rose, et al, 2000;van Dijk et al, 2007). Presumably, most incidents of unexplainable syncope are reflex syncope, also known as vasovagal syncope.…”

Section: Introductionmentioning

confidence: 91%