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International Heart Journal 2015Autonomic dysfunction has been associated with paroxysmal atrial fibrillation (PAF). The head-up tilt test (HUTT) is an important diagnostic tool for autonomic...
Autonomic dysfunction has been associated with paroxysmal atrial fibrillation (PAF). The head-up tilt test (HUTT) is an important diagnostic tool for autonomic dysfunction. The aim of this study was to examine atrial fibrillation recurrence after RFCA by performing HUTT. A total of 488 consecutive patients with PAF who underwent RFCA were prospectively enrolled. HUTT was positive in 154 (31.6%) patients after a mean follow-up of 22.7 ± 3.5 months, and 163 (33.4%) had a recurrence. HUTT positive was significantly higher in PAF patients with recurrence compared to those without (68 (41.7%) versus 86 (26.5%), P < 0.001). Multivariate Cox regression analysis revealed that HUTT positive (HR: 1.96; 95% CI: 1.49-2.48, P < 0.001), left atrial diameter (HR: 1.77; 95%CI: 1.15-2.11, P = 0.004), AF duration (HR: 1.27; 95%CI: 0.98-1.83, P = 0.014), and sleep apnea (HR: 1.02; 95%CI: 0.81-1.53, P = 0.032) were independent predictors of clinical recurrence after RFCA. The success rate of ablation was 70.4% in patients in the HUTT negative group compared with 58.4% in patients in the HUTT positive group (log-rank P = 0.006). Patients with a positive headup tilt test were at an increased risk of AF recurrence after catheter ablation. Our results suggest that HUTT was a significant predictor for AF recurrence after catheter ablation for PAF.
Topics: Adult; Atrial Fibrillation; Autonomic Nervous System; Catheter Ablation; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Recurrence; Reproducibility of Results; Risk Factors; Syncope, Vasovagal; Tilt-Table Test
PubMed: 26370369
DOI: 10.1536/ihj.15-039 -
Heart Rhythm Sep 2023
Topics: Humans; Syncope, Vasovagal
PubMed: 37379939
DOI: 10.1016/j.hrthm.2023.06.017 -
Dermatologic Surgery : Official... Dec 2018A vasovagal reaction is a commonly encountered event in outpatient procedures. There is a paucity of discussion on vasovagal reactions (VVRs) in the dermatologic surgery... (Review)
Review
BACKGROUND
A vasovagal reaction is a commonly encountered event in outpatient procedures. There is a paucity of discussion on vasovagal reactions (VVRs) in the dermatologic surgery literature. However, recent investigations in the physiology, evaluation, and treatment of VVRs have been reported in other specialties.
OBJECTIVE
A comprehensive review of the physiology, evaluation, treatment, and prevention of VVRs.
MATERIALS AND METHODS
A search as performed using the PubMed/MEDLINE databases. Search terms included "vasovagal," "vasovagal reaction," "syncope," "reflex syncope," "neurocardiogenic syncope," and "fainting."
RESULTS
Studies demonstrate greater understanding in the physiology of a vasovagal reaction. Although permanent sequelae are uncommon, it is important to respond in a prompt manner. A variety of treatment and prevention options are presented.
CONCLUSION
Vasovagal reactions should be carefully evaluated. Additional studies may provide greater data in understanding and managing vasovagal reactions.
Topics: Ambulatory Surgical Procedures; Anxiety; Dermatologic Surgical Procedures; Fear; Humans; Syncope, Vasovagal
PubMed: 29994949
DOI: 10.1097/DSS.0000000000001598 -
Revista Portuguesa de Cardiologia :... Oct 2023
Topics: Humans; Syncope, Vasovagal; Syncope; Catheter Ablation; Tilt-Table Test
PubMed: 37263497
DOI: 10.1016/j.repc.2023.05.008 -
Lakartidningen Feb 2019Syncope is the chief complaint in 1-2 percent of emergency department visits. Syncope belongs to the broader category transient loss of consciousness (TLOC), defined as... (Review)
Review
Syncope is the chief complaint in 1-2 percent of emergency department visits. Syncope belongs to the broader category transient loss of consciousness (TLOC), defined as a short loss of consciousness with loss of awareness and responsiveness, and with subsequent amnesia for the event. Syncope is defined as TLOC due to cerebral hypoperfusion, with rapid onset and spontaneous complete recovery. The main categories of syncope are reflex syncope, orthostatic hypotension, and cardiac syncope. The 2018 guidelines by the European Society of Cardiology emphasizes the process of risk stratification in the initial management of suspected syncope. Risk stratification serves to separate the patients with likely orthostatic and reflex syncope with good prognosis from the patients with likely cardiac syncope and high short-term risk of an adverse outcome. It determines the appropriate next level of care. Further evaluation should be based on clinical suspicion and frequency of symptoms.
Topics: Cardiology; Critical Pathways; Diagnosis, Differential; Disease Management; Europe; Humans; Hypotension, Orthostatic; Practice Guidelines as Topic; Risk Assessment; Societies, Medical; Syncope; Syncope, Vasovagal
PubMed: 31192373
DOI: No ID Found -
Herzschrittmachertherapie &... Jun 2018Pacing for neurocardiogenic or vasovagal syncope (VVS) has been practised for five decades, but the 1986 advent of tilt testing provided a means of diagnosis frequently... (Review)
Review
Pacing for neurocardiogenic or vasovagal syncope (VVS) has been practised for five decades, but the 1986 advent of tilt testing provided a means of diagnosis frequently revealing, in the early days, asystole caused by VVS. This was the basis for pacing these patients and the first studies created enthusiasm followed by randomised controlled trials, which were imperfectly designed, "confirming" benefit. When better trial design was employed, there was no obvious benefit. However, some cardiologists had seen patients experience a huge positive difference with pacing, so they set out to identify them. Two studies using ECG loop recorders to document heart rhythm during spontaneous attacks allowed better patient selection for pacing and appeared to achieve the aim. Further, it was noted in the second study, a randomised controlled trial (RCT) with good design, that tilt testing added a further dimension to the identification of the patient who would benefit. Thus, loop recorders are used to show asystole in spontaneous attacks and when tilt testing is negative, implying a lesser vasodepressor component, the patient will have the best outcome. From the available evidence, pacing should be dual-chamber in older patients (>40 years) with severe symptoms and in whom standard measures have demonstrably failed. The method of triggering pacing and its timing of introduction have not yet been resolved. Today's method is rate-hysteresis but there is another sensed event as an alternative: right ventricular impedance, which is now in RCT with substantial pilot evidence in its favour.
Topics: Cardiac Pacing, Artificial; Humans; Syncope, Vasovagal
PubMed: 29802445
DOI: 10.1007/s00399-018-0564-0 -
Nederlands Tijdschrift Voor Geneeskunde Mar 2022Although transient loss of consciousness (TLOC) is a common problem, hospital care for patients with TLOC is characterised by high rates of no diagnosis and...
Although transient loss of consciousness (TLOC) is a common problem, hospital care for patients with TLOC is characterised by high rates of no diagnosis and misdiagnosis, accompanied by unnecessary hospital admissions and tests. We attribute these problems to increasing specialisation as well as to a blind spot for vasovagal syncope, a condition not claimed by any specialty. We suggest that all doctors seeing patients with TLOC, both in primary and secondary care, should be familiar with the presentations of the relatively harmless vasovagal syncope and the alarm symptoms of potentially life-threatening cardiac syncope. In this article we present some practical pointers to recognise these conditions and answer some frequently-asked questions regarding the diagnosis and treatment of TLOC.
Topics: Humans; Physical Therapy Modalities; Syncope; Syncope, Vasovagal; Transients and Migrants; Unconsciousness
PubMed: 35499679
DOI: No ID Found -
Heart Rhythm May 2020
Topics: Humans; Pacemaker, Artificial; Patient Selection; Syncope, Vasovagal; Tilt-Table Test
PubMed: 32113895
DOI: 10.1016/j.hrthm.2020.02.026 -
Vaccine Sep 2022Coronavirus disease 2019 (COVID-19) vaccine administration started in February 2021 in Japan. As of December 2021, approximately 75% of the population aged ≥12 years...
Coronavirus disease 2019 (COVID-19) vaccine administration started in February 2021 in Japan. As of December 2021, approximately 75% of the population aged ≥12 years had received two doses of vaccine. We conducted a study to investigate vasovagal reactions (VVR) after COVID-19 vaccination using data on adverse events following immunization. The crude reporting rate of VVR (cases/1,000,000 doses) after vaccination was 9.6 in all age groups combined, and was more frequent in the younger age groups: 28.6 and 37.2 in individuals aged 10-19 years and 20-29 years, respectively. In individuals aged 10-29 years, the rate was similar in males and females (33.0 and 34.2, respectively, p = 0.53); but was higher after dose 1 than after dose 2 (57.4 and 8.8, respectively, p < 0.001). Based on these results, caution needs to be exercised when vaccinating adolescents and young adults, especially with dose 1 of COVID-19 vaccines.
Topics: Adolescent; Adult; COVID-19; COVID-19 Vaccines; Child; Female; Humans; Japan; Male; Syncope, Vasovagal; Vaccination; Young Adult
PubMed: 36068111
DOI: 10.1016/j.vaccine.2022.08.056 -
Brain and Nerve = Shinkei Kenkyu No... Aug 2022Syncope is defined as the transient loss of consciousness due to cerebral hypoperfusion. Reflex syncope (neurally mediated syncope) is among all syncope, vasovagal...
Syncope is defined as the transient loss of consciousness due to cerebral hypoperfusion. Reflex syncope (neurally mediated syncope) is among all syncope, vasovagal syncope is among reflex syncope in addition. We frequently treated several patients with vasovagal syncope in our clinical situation. We report here the mechanisms and treatments of vasovagal syncope. Although this syncope has a low risk, the diagnosis and the treatments are complicated. Therefore, invasive treatments are necessary in selected patients. This article discusses the management procedures of syncope according to the guidelines and our clinical experience.
Topics: Consciousness; Humans; Syncope; Syncope, Vasovagal
PubMed: 35941792
DOI: 10.11477/mf.1416202162