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Dental Clinics of North America Jul 2023Patients with extreme dental anxiety and dental phobia are candidates for syncope attacks in a dental chair. Early recognition and management of these episodes is... (Review)
Review
Patients with extreme dental anxiety and dental phobia are candidates for syncope attacks in a dental chair. Early recognition and management of these episodes is important. Vasovagal syncope is often preceded by prodromal signs and symptoms like facial pallor, diaphoresis, fainting, dizziness, nausea, or vomiting. If any element of the patient's airway, breathing, or cardiovascular system is no longer intact, the provider should commence emergency basic life support protocols and notify emergency medical services immediately.
Topics: Humans; Syncope; Syncope, Vasovagal; Anxiety
PubMed: 37244725
DOI: 10.1016/j.cden.2023.02.029 -
Current Cardiology Reports Dec 2023Vasovagal syncope (VVS) is a common entity causing transient loss of consciousness and affecting quality of life. Guideline-recommended therapy involves conservative... (Review)
Review
PURPOSE OF REVIEW
Vasovagal syncope (VVS) is a common entity causing transient loss of consciousness and affecting quality of life. Guideline-recommended therapy involves conservative measures and pacing in selected patients. Cardioneuroablation (CNA) targeting the ganglionated plexi in the heart has been shown to reduce excessive vagal excitation, which plays a major role in the pathophysiology of VVS and functional bradycardia.
RECENT FINDINGS
The introduction of CNA has fueled research into its value for the treatment of VVS. Multiple observational studies and one randomized trial have demonstrated the safety and efficacy of CNA and the positive impact on quality of life. This review describes the rationale and CNA procedural techniques and outcomes. Patient selection and future directions have also been described. Cardioneuroablation is a promising treatment for patients with recurrent VVS and functional bradycardia. Further large-scale randomized studies are needed to further verify the safety and efficacy of this approach.
Topics: Humans; Bradycardia; Syncope, Vasovagal; Quality of Life; Heart
PubMed: 37982935
DOI: 10.1007/s11886-023-01997-1 -
Cardiology in the Young May 2022Recent studies confirm the role of B vitamins deficiency and hyperhomocysteinaemia in the development of dysautonomia that has been considered to be the main factor in...
BACKGROUND
Recent studies confirm the role of B vitamins deficiency and hyperhomocysteinaemia in the development of dysautonomia that has been considered to be the main factor in vasovagal syncope development. The aim of the study was to investigate serum pyridoxine, folate, cobalamin, and homocysteine levels in children presenting with vasovagal syncope and to analyse the correlation between them and main clinical parameters of syncope.
METHODS
We studied 40 children, ages 8-17 years with a history of vasovagal syncope and 24 healthy volunteers. The serum pyridoxine, folate, cobalamin, and homocysteine levels were measured by a quantitative sandwich enzyme immunoassay technique using a commercial kit (Monobind, USA). Twenty-four-hour Holter monitoring and 24-hour ambulatory blood pressure monitoring were conducted for all participated patients.
RESULTS
Serum pyridoxine (9.42 ± 4.87, 16.11 ± 5.53 µg/L) and cobalamin (307.48 ± 95.50, 447.28 ± 108.85 ng/L) levels were reasonably low (p < 0.05) in patients with vasovagal syncope. Although there was no significant change in folate levels between syncope and healthy children (4.00 ± 1.34, 4.71 ± 1.73 µg/L; p = 0.20), we detected low folate-level association with longer duration of syncope (r = -0.42) and post syncope (r = -0.43) symptoms (p < 0.05). Finally, there was increased serum homocysteine level (13.55 ± 5.03, 7.81 ± 1.71 µmol/L; p < 0.05) in patients with vasovagal syncope. It was positively correlated with the average PQ interval (r = 0.35, p < 0.05) and average QTc interval (r = 0.49, p < 0.05).
CONCLUSIONS
The results suggested that pyridoxine, folate, cobalamin, and homocysteine may be involved in the pathogenesis of vasovagal syncope. This might provide a new approach for effective treatment of paediatric vasovagal syncope, requiring further study.
Topics: Adolescent; Blood Pressure Monitoring, Ambulatory; Child; Folic Acid; Homocysteine; Humans; Pyridoxine; Syncope, Vasovagal; Vitamin B 12
PubMed: 34321136
DOI: 10.1017/S1047951121003036 -
The Journal of International Medical... Sep 2022Vasovagal reaction (VVR) is an adverse reaction to blood donation. Applied muscle tension (AMT) has been reported to reduce the probability of VVR during blood donation;... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Vasovagal reaction (VVR) is an adverse reaction to blood donation. Applied muscle tension (AMT) has been reported to reduce the probability of VVR during blood donation; however, the results have been controversial. We therefore conducted a meta-analysis to systematically evaluate the effect of AMT in reducing VVR.
METHODS
We searched six major databases using "applied muscle tension" and "blood donation-related vasovagal response" as keywords. Relevant articles published in English or Chinese between 1 January 2000 and 30 June 2021 were included in the analysis. The quality of the included articles was evaluated and publication bias was assessed by forest and funnel plots and by Egger's test.
RESULTS
Fifty-one articles were identified, of which six were included according to the pre-defined inclusion and exclusion criteria. A fixed-effects model was adopted for effect size combination and revealed a relative risk of 0.52 (95% confidence interval 0.40 to 0.67). The AMT group was superior to the control in terms of VVR prevention. A funnel plot and Egger's test suggested that the findings were accurate and reliable with low publication bias.
CONCLUSION
AMT could effectively reduce VVR during blood donation. Further multicenter studies with large sample sizes are needed to confirm these results.
Topics: Blood Donors; Humans; Muscle Tonus; Publication Bias; Risk; Syncope, Vasovagal
PubMed: 36127814
DOI: 10.1177/03000605221121958 -
Archives of Dermatological Research Sep 2022Although vasovagal syncopal episodes (VSE) are a well-known complication of dermatologic surgery, there are currently no studies that report an incidence of VSE in Mohs...
Although vasovagal syncopal episodes (VSE) are a well-known complication of dermatologic surgery, there are currently no studies that report an incidence of VSE in Mohs surgery specifically. This study aims to provide data on the incidence of VSE in Mohs surgery by reviewing VSE incident reports from a private, community-based, outpatient Mohs surgery clinic. We report an incidence of VSE of 0.09% in Mohs surgery. This study offers the first data on the incidence of VSE during Mohs surgery and suggests that the incidence of VSE in Mohs surgery may be lower than what has been quoted as the reference standard for dermatologic surgery.
Topics: Humans; Incidence; Mohs Surgery; Syncope, Vasovagal; Tilt-Table Test
PubMed: 33710391
DOI: 10.1007/s00403-021-02215-0 -
Transfusion Medicine (Oxford, England) Feb 2016Vasovagal reactions (VVRs) in blood donors have significant implications for the welfare of donors, donor retention and the management of donor sessions. We present a... (Meta-Analysis)
Meta-Analysis Review
Vasovagal reactions (VVRs) in blood donors have significant implications for the welfare of donors, donor retention and the management of donor sessions. We present a systematic review of interventions designed to prevent or reduce VVRs in blood donors. Electronic databases were searched for eligible randomised trials to March 2015. Data on study design and outcomes were extracted and pooled using random effects meta-analyses. Sixteen trials met the inclusion criteria: five trials (12 042 participants) of pre-donation water, eight trials (3500 participants) of applied muscle tension (AMT) and one trial each of AMT combined with water, caffeine, audio-visual distraction and/or social support. In donors receiving pre-donation water, the relative risk (RR) compared with controls for VVRs was 0·79 [95% confidence interval (CI) 0·70-0·89, P < 0·0001] and the mean difference (MD) in severity of VVRs measured with the Blood Donation Reactions Inventory (BDRI) score was -0·32 (95% CI -0·51 to -0·12, P < 0·0001). Excluding trials with a high risk of selection bias, the RR for VVRs was 0·70 (95% CI 0·45-1·11, P = 0·13). In donors who received AMT, there was no difference in the risk of chair recline in response to donor distress from controls (RR 0·76, 95% CI 0·53-1·10, P = 0·15), although the MD in BDRI score was -0·07 (95% CI -0·11 to -0·03, P = 0·0005). There was insufficient data to perform meta-analysis for other interventions. Current evidence on interventions to prevent or reduce VVRs in blood donors is indeed limited and does not provide strong support for the administration of pre-donation water or AMT during donation. Further large trials are required to reliably evaluate the effect of these and other interventions in the prevention of VVRs.
Topics: Blood Donors; Clinical Trials as Topic; Donor Selection; Female; Humans; Male; Risk Factors; Syncope, Vasovagal
PubMed: 27061617
DOI: 10.1111/tme.12275 -
Herzschrittmachertherapie &... Jun 2018Head-up tilt (HUT) has long been used to examine heart rate and blood pressure adaptation to changes in position. During such studies, incidental observations noted that... (Review)
Review
Head-up tilt (HUT) has long been used to examine heart rate and blood pressure adaptation to changes in position. During such studies, incidental observations noted that some test subjects experienced total or near-total transient loss of consciousness and that, in some cases, hypotension was associated with unexpected marked bradycardia compatible with a vasovagal syncope (VVS) reaction. The first report of HUT as a clinical tool to confirm a diagnosis of suspected VVS was published in 1966, and led to the concept of using HUT as a diagnostic tool for VVS. Subsequently, HUT testing, either drug-free or, if necessary, with pharmacological provocation (usually nitroglycerin) has proven to be a useful and safe modality for identifying susceptibility to VVS. In this regard, it is recognized that VVS is best diagnosed by careful history taking. Unfortunately, the history may be non-diagnostic; HUT may be helpful in such cases. However, the interpretation of HUT requires care and experience; in particular, the outcome must be consistent with the patient's clinical presentation. The reproduction of patient symptoms may not only provide a diagnosis, but also offer some comfort to the patient and family in that the medical team has documented the basis of symptoms and are thereby positioned to address therapy.
Topics: Blood Pressure; Heart Rate; Humans; Syncope, Vasovagal; Tilt-Table Test
PubMed: 29696345
DOI: 10.1007/s00399-018-0568-9 -
Critical Pathways in Cardiology Sep 2023Vasovagal syncope (VVS) is largely a benign condition focused on patient education, lifestyle modification, and avoidance of triggers. However, a subset of patients may... (Review)
Review
Vasovagal syncope (VVS) is largely a benign condition focused on patient education, lifestyle modification, and avoidance of triggers. However, a subset of patients may benefit from permanent pacemaker placement. Commonly, patients with VVS are younger and those requiring pacing have symptoms associated with severe cardioinhibitory syncope. With the advent of leadless pacemaker systems, a lot of the risks associated with traditional transvenous pacemaker systems are mitigated. In this article, we provide a comprehensive review of the data available for the treatment of cardioinhibitory vasovagal syncope using leadless pacemaker systems.
Topics: Humans; Syncope, Vasovagal; Cardiac Pacing, Artificial; Pacemaker, Artificial
PubMed: 37249900
DOI: 10.1097/HPC.0000000000000325 -
Clinical Physiology and Functional... Mar 2024Tilt table testing (TTT) has been used for decades to study short-term blood pressure (BP) and heart rate regulation during orthostatic challenges. TTT provokes... (Review)
Review
Tilt table testing (TTT) has been used for decades to study short-term blood pressure (BP) and heart rate regulation during orthostatic challenges. TTT provokes vasovagal reflex in many syncope patients as a background of widespread use. Despite the availability of evidence-based practice syncope guidelines, proper application and interpretation of TTT in the day-to-day care of syncope patients remain challenging. In this review, we offer practical information on what is needed to perform TTT, how results should be interpreted including the Vasovagal Syncope International Study classification, why syncope induction on TTT is necessary in patients with unexplained syncope and on indications for TTT in syncope patient care. The minimum requirements to perform TTT are a tilt table with an appropriate tilt-down time, a continuous beat-to-beat BP monitor with at least three electrocardiogram leads and trained staff. We emphasize that TTT remains a valuable asset that adds to history building but cannot replace it, and highlight the importance of recognition when TTT is abnormal even without syncope. Acknowledgement by the patient/eyewitness of the reproducibility of the induced attack is mandatory in concluding a diagnosis. TTT may be indicated when the initial syncope evaluation does not yield a certain, highly likely, or possible diagnosis, but raises clinical suspicion of (1) reflex syncope, (2) orthostatic hypotension (OH), (3) postural orthostatic tachycardia syndrome or (4) psychogenic pseudosyncope. A therapeutic indication for TTT in the patient with a certain, highly likely or possible diagnosis of reflex syncope, may be to educate patients on prodromes. In patients with reflex syncope with OH TTT can be therapeutic to recognize hypotensive symptoms causing near-syncope to perform physical countermanoeuvres for syncope prevention (biofeedback). Detection of hypotensive susceptibility requiring therapy is of special value.
Topics: Humans; Reproducibility of Results; Tilt-Table Test; Syncope; Syncope, Vasovagal; Hypotension, Orthostatic; Heart Rate
PubMed: 37839043
DOI: 10.1111/cpf.12859 -
Pacing and Clinical Electrophysiology :... Nov 2017Vasovagal syncope (VVS) or neurocardiogenic syncope is defined by transient loss of consciousness with spontaneous and rapid recovery. Recently, a closed loop... (Review)
Review
Vasovagal syncope (VVS) or neurocardiogenic syncope is defined by transient loss of consciousness with spontaneous and rapid recovery. Recently, a closed loop stimulation (CLS) pacing system has emerged as a new strategy which appears superior to conventional pacing for patients with refractory syncope. However, its efficacy remains of considerable debate and large randomized controlled clinical trials are needed. Between 2002 and 2017, 12 total studies evaluated the use of CLS pacing in patients with refractory VVS, and are summarized in this article.
Topics: Cardiac Pacing, Artificial; Humans; Pacemaker, Artificial; Syncope, Vasovagal
PubMed: 28895151
DOI: 10.1111/pace.13194