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Heart Rhythm Jan 2024
Topics: Humans; Bradycardia; Syncope, Vasovagal; Atrioventricular Block; Sick Sinus Syndrome; Catheter Ablation
PubMed: 37776935
DOI: 10.1016/j.hrthm.2023.09.023 -
Internal Medicine (Tokyo, Japan) Jun 2020Vasovagal reactions are the most common type of adverse reaction after blood donation; however, there are no reports of ischemic colitis as an adverse reaction after...
Vasovagal reactions are the most common type of adverse reaction after blood donation; however, there are no reports of ischemic colitis as an adverse reaction after blood donation. A previously healthy 55-year-old woman suffered loss of consciousness at the end of her first plasma donation. She was diagnosed with a vasovagal reaction and received hydration. However, she developed persistent left flank pain and watery diarrhea, followed by bloody diarrhea. Abdominal computed tomography confirmed ischemic colitis. She was asked to fast and was eventually discharged 7 days later. We should consider the possibility of ischemic colitis if patients develop persistent abdominal pain after transient hypotension, such as that observed during a vasovagal reaction.
Topics: Blood Donors; Colitis, Ischemic; Diagnostic Tests, Routine; Female; Humans; Middle Aged; Syncope, Vasovagal; Tomography, X-Ray Computed
PubMed: 32188808
DOI: 10.2169/internalmedicine.4219-19 -
Transfusion Jan 2021This longitudinal study of high school whole blood donors examined relationships among donation-related fears assessed prior to donation, vasovagal reactions to...
BACKGROUND
This longitudinal study of high school whole blood donors examined relationships among donation-related fears assessed prior to donation, vasovagal reactions to donation, and the proportion of donors who attempted another donation over the subsequent 60 weeks.
STUDY DESIGN AND METHODS
Data regarding vasovagal reactions and attempted donation were obtained from donor records of 530 female and 342 male high school donors who answered questions about five types of fear (ie, of blood draw, needles, seeing blood, feeling pain, or fainting) prior to their index donation.
RESULTS
Each type of fear was associated with an increased risk of vasovagal reactions (all P < .001) and a smaller percentage of attempted donations was seen among those who reported at least one type of fear (53%) as compared to those who did not report any fear (62.1%); P = .022; β = -0.374, OR = 0.69; 95% CI, 0.50-0.94. Path analyses of the relationships among fear, vasovagal reaction, and attempted donation revealed significant indirect effects for each type of fear. Specifically, donors who reported fear were at increased odds of experiencing a vasovagal reaction, which, in turn, was associated with decreased odds of attempting a repeat donation.
CONCLUSION
Donation-related fears are associated with reduced donor return rates, and this effect is mediated through an increased risk for vasovagal reactions. For both practical and ethical reasons, blood collectors are encouraged to identify and intervene with fearful donors to reduce the likelihood of negative donation-related symptoms and enhance donor retention.
Topics: Blood Donors; Correlation of Data; Fear; Female; Humans; Longitudinal Studies; Male; Needles; Pain; Risk Factors; Schools; Students; Syncope; Syncope, Vasovagal
PubMed: 32997822
DOI: 10.1111/trf.16099 -
Journal of Interventional Cardiac... Nov 2020Vasovagal syncope (VVS) is the most common type of syncope; the lone cardioinhibitory syncope represents only a small group of patients; however, the "cardioinhibitory... (Review)
Review
Vasovagal syncope (VVS) is the most common type of syncope; the lone cardioinhibitory syncope represents only a small group of patients; however, the "cardioinhibitory component" is highly prevalent in reflex syncope and can be severe enough to produce asystole, lasting for a few seconds followed by a recovery to sinus beats. The environment in which syncope occurs can compromise life, and in-depth knowledge of the disease can prevent deaths and guide the appropriate management. The therapeutic cornerstone is general measures (increase water and salt) followed by pharmacologic therapy; for cardioinhibitory syncope, both treatments fail most of the time, and the next therapeutic option is pacemaker implantation. However, although the pacemaker causes a reduction in syncope, recurrence is high, and a one-time, effective, and safe intervention would be ideal. Cardioneuroablation (CNA) therapy has been proposed as a pacemaker alternative with these characteristics. CNA has shown a high reduction or even complete syncope elimination during 3 years of follow-up in some studies. Patients also reported prolonged prodromal periods, which allowed them enough time to abort the syncope. Invasive therapies like CNA require further extensive cohort studies, randomized clinical trials, and more substantial follow-up to evaluate adverse side effects. This review highlights syncope pathophysiology, dividing it into a central theory and a peripheral theory, the diagnosis explaining the head-up tilt test protocols, and treatments like CAN, representing it with figures for a simplified understanding.
Topics: Cardiac Pacing, Artificial; Humans; Pacemaker, Artificial; Syncope; Syncope, Vasovagal; Tilt-Table Test
PubMed: 32377918
DOI: 10.1007/s10840-020-00758-2 -
PloS One 2016We conducted a cross-sectional study to elucidate factors contributing to vasovagal reaction (VVR), the most frequent side effect following whole blood and apheresis...
We conducted a cross-sectional study to elucidate factors contributing to vasovagal reaction (VVR), the most frequent side effect following whole blood and apheresis donations. Complications recorded at the collection sites after voluntary donations by the Japanese Red Cross Tokyo Blood Center (JRC), in the 2006 and 2007 fiscal years, were analyzed by both univariate analysis and the multivariate conditional logistic regression model. Of 1,119,716 blood donations over the full two years, complications were recorded for 13,320 donations (1.18%), among which 67% were VVR. There were 4,303 VVR cases which had sufficient information and could be used for this study. For each VVR case, two sex- and age-matched controls (n = 8,606) were randomly selected from the donors without complications. Age, sex, body mass index (BMI), predonation blood pressure, pulse and blood test results, including total protein, albumin, and hemoglobin, were compared between the VVR group and the control group. In univariate analysis, the VVR group was significantly younger, with a lower BMI, higher blood pressure and higher blood protein and hemoglobin levels than the control group (p<0.001). Furthermore, blood protein and hemoglobin levels showed dose-dependent relationships with VVR incidences by the Cochran-Armitage trend test (p<0.01). For both sexes, after adjusting for confounders with the multivariate conditional logistic regression model, the higher than median groups for total protein (male: OR 1.97; 95%CI 1.76,-2.21; female: OR 2.29; 95%CI 2.05-2.56), albumin (male: 1.75; 1.55-1.96; female: 1.76; 1.57-1.97) and hemoglobin (male: 1.98; 1.76-2.22; female: 1.62; 1.45-1.81) had statistically significant higher risk of VVR compared to the lower than median groups. These elevated serum protein and hemoglobin levels might offer new indicators to help understand VVR occurrence.
Topics: Adult; Blood Donors; Blood Pressure; Blood Proteins; Case-Control Studies; Female; Hemoglobins; Humans; Male; Odds Ratio; Sex Factors; Syncope, Vasovagal; Young Adult
PubMed: 26894814
DOI: 10.1371/journal.pone.0148854 -
Journal of Cardiovascular... Jun 2021Cardioneuroablation (CNA) is an emerging technique being used to treat patients with cardioinhibitory vasovagal syncope (VVS). We describe a case of CNA in targeting...
BACKGROUND
Cardioneuroablation (CNA) is an emerging technique being used to treat patients with cardioinhibitory vasovagal syncope (VVS). We describe a case of CNA in targeting atrial ganglionated plexi (GP) based upon anatomical landmarks and fractionated electrogram (EGM) localization in a patient with cardioinhibitory syncope.
CASE PRESENTATION
A 20-year-old healthy female presented with malignant VVS and symptomatic sinus pauses, with the longest detected at 10 s. She underwent acutely successful CNA with demonstration of vagal response (VR) noted after ablation of left sided GP, and tachycardia noted with right sided GP ablation. All GP sites were defined by anatomical landmarks and EGM analysis. By using the fractionation mapping software of Ensite Precision mapping system with high density mapping, fragmented EGMs were successfully detected in each GP site. One month after vagal denervation, there were no recurrent syncopal episodes or sinus pauses. Longer term follow-up with implantable loop recorder is planned.
CONCLUSION
We performed CNA in a patient with VVS by utilizing a novel approach of combined use of high density mapping and fractionation mapping software. With this approach, we were able to detect fractionation in all GP sites and demonstrate acute VR. This workflow may allow for a new, standardized technique suitable for widespread use.
Topics: Adult; Catheter Ablation; Female; Humans; Syncope, Vasovagal; Vagus Nerve; Young Adult
PubMed: 33855779
DOI: 10.1111/jce.15044 -
Clinical Autonomic Research : Official... Aug 2017Whereas cardiac pacing has a very limited role overall in patients with vasovagal syncope (VVS), there are three reasons which support pacing efficacy in tilt-induced... (Review)
Review
Whereas cardiac pacing has a very limited role overall in patients with vasovagal syncope (VVS), there are three reasons which support pacing efficacy in tilt-induced asystolic VVS. These are: (1) contrary to mixed and vasodepressor forms, an asystolic tilt response is specific, i.e., diagnostic, of VVS and is unlikely to occur in control patients without history of syncope and in patients with cardiac syncope; (2) contrary to mixed and vasodepressor forms, an asystolic tilt response predicts a similar asystolic event during prolonged ECG monitoring with a positive predictive value of 86%; (3) the available evidence from trials supports the efficacy of dual-chamber pacing with a low recurrence rate of syncope after pacing ranging from 6% up to 23% during 3 years of follow-up. The latter results should be confirmed by an ongoing double-blind randomized controlled trial before cardiac pacing becomes an established indication. It is commonly believed that the most frequent cause of recurrence of syncope in patients treated with a pacemaker is an associated hypotensive reflex. In these cases additional measures should be used to counteract hypotension. Recognizing prodromal symptoms, avoiding triggers, and performing counterpressure maneuvers are the well-known first steps. There are two additional useful measures when these fail: stopping/reducing hypotensive drugs and (in selected cases) adding fludrocortisone.
Topics: Cardiac Pacing, Artificial; Heart Arrest; Humans; Syncope, Vasovagal; Tilt-Table Test
PubMed: 28669088
DOI: 10.1007/s10286-017-0441-7 -
Autonomic Neuroscience : Basic &... Sep 2014The ECG registration during syncope allows physicians either to confirm or exclude an arrhythmia as the mechanism of syncope. Implantable loop recorders have an... (Review)
Review
The ECG registration during syncope allows physicians either to confirm or exclude an arrhythmia as the mechanism of syncope. Implantable loop recorders have an over-writeable memory buffer that continuously records and deletes the patient's ECG for up to three years. Many studies have analyzed the utility of implantable loop recorders in recurrent unexplained or high risk syncope. These studies suggest that early use of the ILR provides more and earlier diagnoses and could help in selecting patients with vasovagal syncope and prolonged asystolic pauses who might benefit from pacemaker therapy. However many questions remain, including its performance in the community by physicians with a range of experience in diagnosing syncope. Furthermore there is no evidence that the use of the ILR changes outcome. Numerous attempts have been made to determine whether patients with predominantly cardioinhibitory syncope benefit from permanent pacemakers, especially if symptoms are frequent and debilitating. While the first open label trials of pacemakers in the treatment of vasovagal syncope showed promising results, this effect has not been confirmed by blinded randomized clinical trials. More recent data seem to suggest that patients over 40years with severe asystolic vasovagal syncope might benefit from permanent pacemakers.
Topics: Cardiac Pacing, Artificial; Humans; Pacemaker, Artificial; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Syncope, Vasovagal
PubMed: 24916847
DOI: 10.1016/j.autneu.2014.05.012 -
Clinical Autonomic Research : Official... Jun 2021
Topics: Humans; Research Design; Syncope, Vasovagal; Tilt-Table Test
PubMed: 33961160
DOI: 10.1007/s10286-021-00809-2 -
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