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Hellenic Journal of Cardiology : HJC =... 2023Cardioneuroablation is an emerging alternative therapeutic modality for young patients with severe neurally-mediated syncope. We present two images of...
Cardioneuroablation is an emerging alternative therapeutic modality for young patients with severe neurally-mediated syncope. We present two images of cardioneuroablation performed in young patients who suffered from recurrent neurally-mediated syncope with asystole and functional atrioventricular block. The patients remain syncope-free during follow-ups.
Topics: Humans; Syncope; Syncope, Vasovagal; Heart Arrest
PubMed: 37647986
DOI: 10.1016/j.hjc.2023.08.012 -
Journal of Clinical Apheresis Oct 2023Vasovagal reactions (VVRs) are the most common adverse reactions and are frequently associated with serious donor adverse events. Even mild VVRs can lead to a...
BACKGROUND AND OBJECTIVES
Vasovagal reactions (VVRs) are the most common adverse reactions and are frequently associated with serious donor adverse events. Even mild VVRs can lead to a significant reduction in the likelihood of subsequent donations. The purpose of this study is to explore the factors related to the occurrence of VVRs after plasma donation and to construct a nomogram to identify individuals at risk for VVRs to improve the safety of plasma donors.
MATERIALS AND METHODS
We collected the donation data from July 2019 to June 2020 from a plasma center in Sichuan, China, to explore the independent risk factors for vasovagal reactions. From these data, we constructed and validated a predictive model for vasovagal reactions.
RESULTS
VVRs after plasma donation occurred 737 times in 120 448 plasma donations (0.66%). Gender, season, donor status, weight, pulse, duration of donation, and cycle were independent risk factors for VVRs (P< 0.05). The concordance index (C-index) of a logistic model in the derivation cohort was 0.916, with a Hosmer-Lemeshow goodness-of-fit probability of 0.795. The C-index of a logistic model in the validation cohort was 0.916, with a Hosmer-Lemeshow goodness-of-fit probability of 0.224. The calibration curve showed that the predicted results were in good agreement with the actual observed results.
CONCLUSION
This study preliminarily constructed and verified a prediction model for VVRs after plasma donation. The model nomogram is practical and can identify high-risk donors.
Topics: Humans; Blood Donation; Nomograms; Syncope, Vasovagal; Blood Donors; Risk Factors
PubMed: 37466252
DOI: 10.1002/jca.22074 -
Journal of Interventional Cardiac... Mar 2024Cardioneuroablation has been emerging as a potential treatment alternative in appropriately selected patients with cardioinhibitory vasovagal syncope (VVS) and...
BACKGROUND
Cardioneuroablation has been emerging as a potential treatment alternative in appropriately selected patients with cardioinhibitory vasovagal syncope (VVS) and functional AV block (AVB). However the majority of available evidence has been derived from retrospective cohort studies performed by experienced operators.
METHODS
The Cardioneuroablation for the Management of Patients with Recurrent Vasovagal Syncope and Symptomatic Bradyarrhythmias (CNA-FWRD) Registry is a multicenter prospective registry with cross-over design evaluating acute and long-term outcomes of VVS and AVB patients treated by conservative therapy and CNA.
RESULTS
The study is a prospective observational registry with cross-over design for analysis of outcomes between a control group (i.e., behavioral and medical therapy only) and intervention group (Cardioneuroablation). Primary and secondary outcomes will only be assessed after enrollment in the registry. The follow-up period will be 3 years after enrollment.
CONCLUSIONS
There remains a lack of prospective multicentered data for long-term outcomes comparing conservative therapy to radiofrequency CNA procedures particularly for key outcomes including recurrence of syncope, AV block, durable impact of disruption of the autonomic nervous system, and long-term complications after CNA. The CNA-FWRD registry has the potential to help fill this information gap.
PubMed: 38499825
DOI: 10.1007/s10840-024-01789-9 -
World Journal of Pediatrics : WJP Nov 2023
Topics: Humans; Child; Baroreflex; Syncope, Vasovagal; Syncope; Tilt-Table Test
PubMed: 37014537
DOI: 10.1007/s12519-023-00693-y -
Europace : European Pacing,... Jul 2023
Topics: Humans; Syncope, Vasovagal; Syncope; Reflex
PubMed: 37363927
DOI: 10.1093/europace/euad179 -
Military Medicine Nov 2023Vasovagal syncope is the most common form of syncope seen in young and otherwise healthy active duty service members. Although self-limiting, syncopal events often...
Vasovagal syncope is the most common form of syncope seen in young and otherwise healthy active duty service members. Although self-limiting, syncopal events often produce a significant drain of medical resources because of their sudden and often dramatic presentation, which can be associated with traumatic injuries secondary to loss in postural tone. Malignant differential pathologies associated with syncopal presentation need to be ruled out, which in turn further diminishes resources, especially in a deployed environment that is often in austere, remote locations with a lack of readily available medical supplies. We present a case of vasovagal syncope experienced by a 20-year-old sailor shortly after venipuncture and the 12-lead electrocardiogram captured shortly after presentation. This case highlights the unique electrophysiology during a vasovagal episode and the impact a relatively benign condition has on medical operations in the operational setting.
Topics: Humans; Young Adult; Adult; Syncope, Vasovagal; Phlebotomy; Syncope; Electrocardiography; Electrophysiology
PubMed: 35762141
DOI: 10.1093/milmed/usac178 -
Transfusion Sep 2023COVID-19 convalescent plasma (CCP) is an important therapeutic option for outpatients at high risk of hospitalization from SARS-CoV-2 infection. We assessed the safety...
BACKGROUND
COVID-19 convalescent plasma (CCP) is an important therapeutic option for outpatients at high risk of hospitalization from SARS-CoV-2 infection. We assessed the safety of outpatient CCP transfusions administered during clinical trials.
STUDY DESIGN AND METHODS
We analyzed data pertaining to transfusion-related reactions from two randomized controlled trials in the U.S. that evaluated the efficacy of CCP versus control plasma in various ambulatory settings. Multivariable logistic regression was used to assess whether CCP was associated with transfusion reactions, after adjusting for potential confounders.
RESULTS
The combined study reported 79/1351 (5.9%) adverse events during the transfusion visit, with the majority 62/1351 (4.6%) characterized by mild, allergic-type findings of urticaria, and/or pruritus consistent with minor allergic transfusion reactions; the other reported events were attributed to the patients' underlying disease, COVID-19, or vasovagal in nature. We found no difference in the likelihood of allergic transfusion reactions between those receiving CCP versus control plasma (adjusted odds ratio [AOR], 0.75; 95% CI, 0.43-1.31). Risk of urticaria and/or pruritus increased with a pre-existing diagnosis of asthma (AOR, 2.33; 95% CI, 1.16-4.67). We did not observe any CCP-attributed antibody disease enhancement in participants with COVID-19 or increased risk of infection. There were no life-threatening severe transfusion reactions and no patients required hospitalization related to transfusion-associated complications.
DISCUSSION
Outpatient plasma administration was safely performed for nearly 1400 participants. CCP is a safe therapeutic option for outpatients at risk of hospitalization from COVID-19.
Topics: Humans; COVID-19; COVID-19 Serotherapy; Immunization, Passive; Outpatients; SARS-CoV-2; Transfusion Reaction; Urticaria; Randomized Controlled Trials as Topic
PubMed: 37534607
DOI: 10.1111/trf.17485 -
Scientific Reports Dec 2023This research proposed to retrospectively analyze 20 years of clinical data and investigate the relationship between demographic factors and syncopal symptom in...
This research proposed to retrospectively analyze 20 years of clinical data and investigate the relationship between demographic factors and syncopal symptom in pediatric vasovagal syncope. A total of 2513 children, 1124 males and 1389 females, age range 3-18 years, who presented to Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University with unexplained syncope or pre-syncope and were diagnosed with vasovagal syncope were retrospectively collected and divided into syncope group (n = 1262) and pre-syncope group (n = 1251). (1) Females had a 36% increased risk of syncope compared to males, a 27% increased risk of syncope for every 1-year increase in age, and a 2% decreased risk of syncope for every 1 cm increase in height. (2) A non-linear relationship between age, height, weight and syncope was observed. When age > 10.67 years, the risk of syncope increases by 45% for each 1-year increase in age; when height < 146 cm, the risk of syncope decreases by 4% for each 1 cm increase in height; when weight < 28.5 kg, the risk of syncope decreases by 10% for each 1 kg increase in weight. Demographic factors are strongly associated with syncopal symptom in pediatric vasovagal syncope and can help to predict the risk.
Topics: Male; Female; Humans; Child; Child, Preschool; Adolescent; Syncope, Vasovagal; Retrospective Studies; Syncope; Tilt-Table Test; Demography
PubMed: 38123593
DOI: 10.1038/s41598-023-49722-w -
The Neurohospitalist Jul 2023An 82-year-old female presented to the emergency department with presyncope and was found to be bradycardic with proptosis and ophthalmoparesis. MRI revealed an...
INTRODUCTION
An 82-year-old female presented to the emergency department with presyncope and was found to be bradycardic with proptosis and ophthalmoparesis. MRI revealed an extra-axial enhancing mass compressing the medulla and bilateral enhancing retro-orbital masses.
CASE DESCRIPTION
Imaging, including nuclear medicine bone scan, PET CT, and cardiac MRI raised the suspicion for a histiocytic neoplasm. These findings, along with a fibrohistiocytic infiltrate on bone biopsy and a BRAF V600E oncogenic mutation on plasma cell-free DNA confirmed a diagnosis of Erdheim-Chester disease.
DISCUSSION
These enhancing masses invoke a broad differential, including a histiocytic or granulomatous process, fungal infection, amyloidosis, IgG4 disease, and lymphoma. Systematic laboratory, radiologic, pathology, and genetic testing yielded a diagnosis of this rare histiocytic disorder with frequent neurologic involvement.
PubMed: 37441221
DOI: 10.1177/19418744231168501 -
RoFo : Fortschritte Auf Dem Gebiete Der... Nov 2023To assess radiation exposure and diagnostic performance of bilateral inferior petrosal sinus sampling for the distinction of pituitary and ectopic...
PURPOSE
To assess radiation exposure and diagnostic performance of bilateral inferior petrosal sinus sampling for the distinction of pituitary and ectopic adrenocorticotropin-dependent Cushing's syndrome.
MATERIALS AND METHODS
Procedural data of bilateral inferior petrosal sinus procedures were retrospectively evaluated. The analysis included the patients' clinical and demographic data, procedural radiation exposure, and complication rates, sampling results, clinical course of the patients, and calculation of diagnostic performance data.
RESULTS
The cases of 46 patients diagnosed with adrenocorticotropin-dependent Cushing's syndrome were evaluated. Bilateral inferior petrosal sinus sampling was successfully performed in 97.8 % of the cases. The overall median procedure-related fluoroscopy time was 7.8 min. (range 3.2-36.2 min.), and the median procedural dose area product was 11.9 Gy*cm (range 2.1-73.7 Gy*cm). Radiation doses due to digital subtraction angiography series for visualization of the inferior petrosal sinus were 3.6 Gy*cm (range 1.0-18.1 Gy*cm). Radiation doses due to fluoroscopy had a higher impact on the overall radiation exposure and were significantly influenced by the patients' habitus. The sensitivity, specificity, and positive and negative predictive values were 84 %, 100 %, 100 %, and 72 % before stimulation with corticotropin-releasing hormone, and 97 %, 100 %, 100 %, and 93 % after stimulation. Concordance between magnetic resonance imaging studies and bilateral inferior petrosal sinus sampling results was only found in 35.6 % of the cases. The periprocedural complication rate was 2.2 %, with one patient experiencing vasovagal syncope during catheterization.
CONCLUSION
Bilateral inferior petrosal sinus sampling is a safe procedure with high technical success rates und excellent diagnostic performance. The procedure-related radiation exposure shows large variations and depends on the complexity of cannulation as well as the patients' habitus. Fluoroscopy accounted for the largest proportion of radiation exposure. Acquisition of digital subtraction angiography series for the verification of correct catheter placement appears justified.
KEY POINTS
· Bilateral inferior petrosal sinus sampling with CRH stimulation provides high diagnostic performance in the distinction of pituitary and ectopic Cushing's syndrome.. · The associated radiation exposure is not negligible and is significantly influenced by the use of fluoroscopy and the patients' habitus.. · Digital subtraction angiography contributes less to the overall radiation dose and appears justified for the verification of correct catheter placement..
CITATION FORMAT
· Augustin A, Detomas M, Hartung V et al. Bilateral inferior petrosal sinus sampling: Procedural data from a German single-center study. Fortschr Röntgenstr 2023; 195: 1009 - 1017.
Topics: Humans; Cushing Syndrome; Retrospective Studies; Diagnosis, Differential; Adrenocorticotropic Hormone; Corticotropin-Releasing Hormone; ACTH Syndrome, Ectopic
PubMed: 37224864
DOI: 10.1055/a-2083-9942