News Update on Vasovagal Syncope Research: May – 2019

Electroanatomic-mapping-guided cardioneuroablation versus combined approach for vasovagal syncope: a cross-sectional observational study

Purpose

This study was designed to assess the effectiveness of electroanatomic-mapping (EAM)-guided cardioneuroablation (CNA) vs combined approach for vasovagal syncope (VVS).

Methods

Twenty patients with VVS refractory to standard treatments World Health Organization underwent CNA in our establishment were registered within the study. Twelve of those patients underwent recently introduced EAM-guided CNA mistreatment signal-based approach whereas eight patients underwent combined CNA employing a combination of high-frequency stimulation and spectral analysis. each atria and sinus coronarius were divided into seven segments to reason distribution of ganglionated plexi in ablation sites. Clinical responses were evaluated and compared in terms of prodromic symptoms and syncope repetition rates. Electrophysiological parameters and vital sign variability (HRV) analysis were accustomed value procedural response.

Results

Procedural endpoints were achieved altogether cases with none serious adverse events. Compared with the combined approach cluster, EAM-guided CNA was associated with a shorter procedure and radiology times (p [1]

Acceleration Index Predicts Efficacy of Orthostatic Training on Vasovagal Syncope in Children

Objective

To explore the worth of the acceleration index as a predictor of therapeutic response to vertical coaching in kids with vasovagal syncope (VVS).

Study style

Thirty-three kids with VVS were recruited and treated with vertical coaching. The therapeutic response of every patient was evaluated once three months of treatment. A Pearson correlation was calculated between the acceleration index and also the severity of VVS. the worth of the acceleration index in predicting the therapeutic response to vertical coaching was assessed by analysis of the receiver in operation graphical record.

Results

Among the thirty three kids with VVS, twenty were found to be responders and also the remaining were nonresponders. The mean acceleration index was considerably lower in responders compared with nonresponders (21.10 ± 6.61 vs 31.36 ± 9.00; P = .001) and it absolutely was negatively correlative with positive time interval within the head-up tilt take a look at, with heartbeat pressure level and with heartbeat blood pressure at positive time interval within the head-up tilt take a look at (P [2]

Greater early epinephrine rise with head‐up posture: A marker of increased syncope susceptibility in vasovagal fainters

Background

Head‐up tilt (HUT) is wide used for diagnostic analysis of patients with suspected vasovagal syncope (VVS), however additionally offers a chance to check VVS pathophysiology. during this regard, it’s best-known that plasma internal secretion (Epi) levels and Epi/norepinephrine (NE) quantitative relation are markedly enlarged from baseline at the time of HUT‐induced VVS. However, whether or not these changes contribute to VVS condition remains unsure.

Objective

We hypothesized that if catecholamines contributed to VVS directly, then a larger increase of plasma self-report personality inventory and Epi/NE quantitative relation early throughout HUT would be related to shorter time to syncope.

Methods

The patient population comprised thirty three people (14 men, 43 ± 2 years) with suspected VVS in whom 70° HUT reproduced symptoms. blood vessel self-report personality inventory and NE concentrations were collected at baseline (supine) and 2 minutes of HUT. Linear, exponential, and multiple correlation were wont to access the association between dynamic  internal secretion levels and time to syncope.

Results

Mean ± SD time to positive HUT was eleven (7.6) minutes. Higher plasma self-report personality inventory levels (pg/mL) each at baseline and at 2 minutes upright related to with shorter time to syncope (baseline, R = −0.35, P = 0.048; and 2 minutes, R = −0.58, P = 0.001). Similarly, a larger Epi/NE quantitative relation at 2 minutes head‐up related to with earlier time to syncope (R = −0.49, P = 0.007). These relationships remained vital once adjusting for age and sex (P = 0.006 and 0.02, respectively).

Conclusion

Greater self-report personality inventory levels and Epi/NE quantitative relation early throughout HUT were related to shorter time to VVS, suggesting a doable contribution to VVS condition. [3]

The complexity of hemodynamic response to the tilt test with and without nitroglycerine provocation in patients with vasovagal syncope

The paper presents a comparison of vasovagal syndrome prevalence during a be tilt table take a look at between patients with a positive results of passive tilt test and people with a positive result once pharmacologic provocation. The study cluster consisted of eighty patients: fifty seven patients WHO older syncope within the passive section of the take a look at (43 girls (aged: thirty five.6 ± 16.2) and fourteen men (aged: forty one.7 ± 15.6) and twenty three patients WHO older syncope once pharmacologic provocation (17 girls (age: thirty two.3 ± 12) and half dozen men (age: 43 ± 15). the most investigation was supported the assessment of monitored signals complexity: pulse rate, pressure and stroke volume. The analysis of quality in chosen mensuration phases was performed with Sample Entropy. The investigation showed that the reactions of involuntary system throughout tilt take a look at and before syncope are similar for positive results of passive tilt test and positive result of tilt test with provocation. The variations in supine position occurred solely in analysis supported ohmic resistance mensuration (SV: p = 0.01). important variations were denoted for all signals simply before the syncope (RRI, sBP, dBP: p = 0,00001 and SV: p = 0.01). In analysis of signals quality the numerous variations occurred simply before the syncope for Sample Entropy of pressure (SampEn (sBP): p = 0.0008, SampEn (dBP): p = 0,0001). [4]

Outcomes of Fast-track Outpatient Clinic for Rhythm and Conduction Disorders: Focus on Postural Tachycardia Syndrome and Literature Review

Aims: to focus on the outcomes of nurse-led fast-track patient clinic for rhythm and conductivity disturbances yielding patients with bodily property cardiac arrhythmia syndrome.

Patients and Methods: within the setting of fast-track nurse-led patient clinic for rhythm and conductivity disturbances of 483 Caucasian subjects UN agency were evaluated for palpitation, presyncope and syncope, fatigue and dyspnoea between might 2014 and August 2016. Analysis for exclusion of any viscus cause enclosed medical record, physical examination, resting cardiogram, laboratory testing, Holter recording, exercise tolerance testing (ETT), diagnostic procedure (TTE), and once bodily property cardiac arrhythmia syndrome (PoTS) was suspected a head-up tilt check (HUT) was performed. During HUT, ECG, encephalogram, pressure was recorded.

Results: centered on patients with PoTS, among forty seven (46 F and one M) subjects UN agency underwent HUT, 10 patients (mean age forty two.1, vary 22-62 years) had PoTS. Patients had a cluster of symptoms and given with a history of presyncope and syncope (n = 7), fatigue (n = 5), mood amendment (n = 5), palpitation (n = 5), nausea (n = 4) and exercise intolerance (n = 3). Resting reclining cardiogram delineate regular sinus rhythm altogether. diagnostic procedure findings were traditional. ETT was traditional in nine and inconclusive in one. Holter recording unconcealed traditional rhythm variation and sinus cardiac arrhythmia (n= 8). PoTS was confirmed throughout HUT check altogether ten subjects. totally different non-pharmacological measures and trials of medicine regimens were initiated.

Conclusions: Fast-track patient clinics for rhythm and conductivity disturbances might cause earlier recognition of PoTS. once PoTS is timely diagnosed, tailored management could also be established. [5]

Reference

[1] Aksu, T., Guler, T.E., Mutluer, F.O., Bozyel, S., Golcuk, S.E. and Yalin, K., 2019. Electroanatomic-mapping-guided cardioneuroablation versus combined approach for vasovagal syncope: a cross-sectional observational study. Journal of Interventional Cardiac Electrophysiology54(2), pp.177-188. (Web Link)

[2] Tao, C., Li, X., Tang, C., Jin, H. and Du, J., 2019. Acceleration Index Predicts Efficacy of Orthostatic Training on Vasovagal Syncope in Children. The Journal of pediatrics207, pp.54-58. (Web Link)

[3] Kohno, R., Detloff, B.L., Chen, L.Y., Norby, F.L. and Benditt, D.G., 2019. Greater early epinephrine rise with head‐up posture: a marker of increased syncope susceptibility in vasovagal fainters. Journal of cardiovascular electrophysiology30(3), pp.289-296. (Web Link)

[4] The complexity of hemodynamic response to the tilt test with and without nitroglycerine provocation in patients with vasovagal syncope

Katarzyna Buszko,Agnieszka Piątkowska,Edward Koźluk,Tomasz Fabiszak &Grzegorz Opolski

Scientific Reportsvolume 8, Article number: 14554 (2018) (Web Link)

[5] A. M. Said, S. and Bloo, R. (2018) “Outcomes of Fast-track Outpatient Clinic for Rhythm and Conduction Disorders: Focus on Postural Tachycardia Syndrome and Literature Review”, Asian Journal of Cardiology Research, 1(1), pp. 1-22. Available at: http://www.journalajcr.com/index.php/AJCR/article/view/24807 (Accessed: 21May2019).(Web Link)

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