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Journal of Cardiovascular Medicine... Feb 2021It is commonly reported that vasovagal syncope (VVS) is more frequent in women. Presently, this issue has never been investigated. The purpose of this review was to... (Review)
Review
It is commonly reported that vasovagal syncope (VVS) is more frequent in women. Presently, this issue has never been investigated. The purpose of this review was to evaluate, through an extensive review of the literature, whether women are really more affected by VVS than men. The gender distribution was investigated in individuals with classical and nonclassical VVS. The database PubMed was searched using the terms 'syncope', 'vasovagal syncope', 'neurally mediated syncope' and 'tilt testing'. Twelve studies dealing with classical and 75 with nonclassical VVS were eligible. In the individuals with classical (N = 1861) and nonclassical VVS (N = 9696), a trend towards a greater percentage of women emerged (P = 0.14 and 0.07, respectively). In the total population with VVS (N = 11 557), the percentage of women was significantly higher than that of men (58 versus 42%, P = 0.03). Most of the individuals were young or middle-aged. In 84% of the studies, the percentage of women was greater than that of men. A separate analysis was carried out in older VVS patients (≥60 years) and only two studies were eligible to be evaluated. Considering that almost all the studies were carried out in the western nations, where the number of men and women is almost superimposable until the age of 65 years and a bias by gender has never been reported in the management of VVS, these data strongly suggest that young and middle-aged women are more affected by VVS than their male counterparts. At present, data are too scant to draw a definitive conclusion in older VVS patients.
Topics: Female; Global Health; Humans; Male; Prevalence; Sex Distribution; Sex Factors; Syncope, Vasovagal; Tilt-Table Test
PubMed: 32925389
DOI: 10.2459/JCM.0000000000001009 -
International Journal of Cardiology Jul 2021
Topics: Cardiac Pacing, Artificial; Humans; Sick Sinus Syndrome; Syncope, Vasovagal
PubMed: 33940095
DOI: 10.1016/j.ijcard.2021.04.050 -
European Heart Journal May 2021Head-up tilt test (TT) has been used for >50 years to study heart rate/blood pressure adaptation to positional changes, to model responses to haemorrhage, to assess...
Head-up tilt test (TT) has been used for >50 years to study heart rate/blood pressure adaptation to positional changes, to model responses to haemorrhage, to assess orthostatic hypotension, and to evaluate haemodynamic and neuroendocrine responses in congestive heart failure, autonomic dysfunction, and hypertension. During these studies, some subjects experienced syncope due to vasovagal reflex. As a result, tilt testing was incorporated into clinical assessment of syncope when the origin was unknown. Subsequently, clinical experience supports the diagnostic value of TT. This is highlighted in evidence-based professional practice guidelines, which provide advice for TT methodology and interpretation, while concurrently identifying its limitations. Thus, TT remains a valuable clinical asset, one that has added importantly to the appreciation of pathophysiology of syncope/collapse and, thereby, has improved care of syncopal patients.
Topics: Autonomic Nervous System Diseases; Heart Rate; Humans; Hypotension, Orthostatic; Syncope; Tilt-Table Test
PubMed: 33624801
DOI: 10.1093/eurheartj/ehab084 -
Frontiers in Neurology 2021Vasovagal syncope () or neurogenically induced fainting has resulted in falls, fractures, and death. Methods to deal with are to use implanted pacemakers or beta...
Vasovagal syncope () or neurogenically induced fainting has resulted in falls, fractures, and death. Methods to deal with are to use implanted pacemakers or beta blockers. These are often ineffective because the underlying changes in the cardiovascular system that lead to the syncope are incompletely understood and diagnosis of frequent occurrences of is still based on history and a tilt test, in which subjects are passively tilted from a supine position to 20° from the spatial vertical (to a 70° position) on the tilt table and maintained in that orientation for 10-15 min. Recently, is has been shown that vasovagal responses (), which are characterized by transient drops in blood pressure (), heart rate (), and increased amplitude of low frequency oscillations in can be induced by sinusoidal galvanic vestibular stimulation (sGVS) and were similar to the low frequency oscillations that presaged in humans. This transient drop in and of 25 mmHg and 25 beats per minute (bpm), respectively, were considered to be a . Similar thresholds have been used to identify in human studies as well. However, this arbitrary threshold of identifying a does not give a clear understanding of the identifying features of a VVR nor what triggers a . In this study, we utilized our model of generation together with a machine learning approach to learn a separating hyperplane between normal and patterns. This methodology is proposed as a technique for more broadly identifying the features that trigger a . If a similar feature identification could be associated with in humans, it potentially could be utilized to identify onset of a , i.e, fainting, in real time.
PubMed: 33776889
DOI: 10.3389/fneur.2021.631409 -
Autonomic Neuroscience : Basic &... Dec 2021It is well known that the autonomic nervous system (ANS) is a major contributor in etiopathogenesis of vasovagal syncope (VVS). Catheter based neuromodulation (CNA) of... (Review)
Review
It is well known that the autonomic nervous system (ANS) is a major contributor in etiopathogenesis of vasovagal syncope (VVS). Catheter based neuromodulation (CNA) of the intrinsic cardiac ANS has evolved rapidly from being an experimental unproven procedure to its current status as an increasingly performed ablation procedure in many major hospitals worldwide. The present review aims to bring the anatomical elements of intrinsic cardiac ANS and clinical application of intrinsic cardiac neuromodulation together, by reviewing anatomical terminologies and clinical data, in order to provide a practical assistance to the electrophysiology community.
Topics: Brain; Catheter Ablation; Heart; Heart Rate; Humans; Syncope, Vasovagal; Vagus Nerve
PubMed: 34666205
DOI: 10.1016/j.autneu.2021.102892 -
Journal of Atrial Fibrillation 2020Vasovagal Syncope (VVS) is mediated by a cardiac autonomic reflex with resultant bradycardia and hypotension, precipitating syncope. While benign and mostly well...
Vasovagal Syncope (VVS) is mediated by a cardiac autonomic reflex with resultant bradycardia and hypotension, precipitating syncope. While benign and mostly well controlled, recurrent VVS can be debilitating and warrants intervention. Non-pharmacological management of VVS have had variable success. In patients with recurrent cardioinhibitory VVS, permanent pacing can be effective. The utility of pacing to preempt the syncopal depends on the prominent temporal role of bradycardia during the vasovagal reflex. Current guidelines recommend pacing as a therapy to consider in older patients with recurrent VVS. Although younger patients can benefit, one should be cautious given the long-term risk of complications. Available data appears to favor a dual chamber pacemaker with closed loop stimulation algorithm to prevent recurrent cardioinhibitory VVS. Several aspects, including mechanistic understanding of VVS and appropriate patient selection, remain unclear, and require further study.
PubMed: 33024506
DOI: 10.4022/jafib.2406 -
Clinical Autonomic Research : Official... Oct 2020
Topics: Humans; Syncope, Vasovagal
PubMed: 32300948
DOI: 10.1007/s10286-020-00689-y -
Vox Sanguinis Apr 2024Risk factors for vasovagal reaction (VVR) have been extensively studied. With knowledge of the relative importance of these risk factors for VVR, collection staff could...
BACKGROUND AND OBJECTIVES
Risk factors for vasovagal reaction (VVR) have been extensively studied. With knowledge of the relative importance of these risk factors for VVR, collection staff could take care of blood donors from the same standpoint, leading to improved donor safety. We therefore developed a scoring system to predict VVR, which incorporates registration information.
MATERIALS AND METHODS
Pre-syncopal and syncopal symptoms, as well as on- and off-site reactions, are included in this analysis as VVR. We defined the donor status as follows: first-time donors, repeat donors with no history of reaction and repeat donors with a history of reaction. We prepared two datasets: whole-blood donations at a blood donation site in Tokyo between January 2019 and December 2019 were included in training data (n = 361,114), and whole-blood donations between January 2020 and August 2020 were included in testing data (n = 216,211).
RESULTS
The most important variable was the donor status, followed by age, estimated blood volume and height. We integrated them into a scoring system. Training and testing datasets were combined (n = 577,325), and VVR rates in groups with scores of 0, 1, 2, 3, 4 and 5 or more were 0.09% (95% CI: 0.081%-0.10%), 0.33% (95% CI: 0.31%-0.36%), 0.87% (95% CI: 0.78%-0.96%), 1.17% (95% CI: 1.05%-1.30%), 2.15% (95% CI: 1.98%-2.32%) and 3.11% (95% CI: 2.90%-3.34%), respectively.
CONCLUSION
The scoring system enables staff to significantly predict VVR and may help them to identify donors at increased risk of experiencing syncope, thereby mitigating the negative impact of VVR on donor safety and return by paying close attention to high-risk donors.
Topics: Humans; Blood Donation; Blood Donors; Syncope, Vasovagal; Risk Factors; Blood Volume
PubMed: 38156553
DOI: 10.1111/vox.13579 -
Clinical Autonomic Research : Official... Feb 2021
Topics: Humans; Physicians; Syncope; Syncope, Vasovagal
PubMed: 33417055
DOI: 10.1007/s10286-020-00763-5 -
Annals of Case Reports 2023Nontraumatic exertional syncope can be an ominous event reflecting profound arterial hypotension, cerebral hypoperfusion, and transient loss-of consciousness that occurs...
Nontraumatic exertional syncope can be an ominous event reflecting profound arterial hypotension, cerebral hypoperfusion, and transient loss-of consciousness that occurs most commonly in patients with underlying cardiovascular disease. In contradistinction, transient loss-of-consciousness in "healthy adults" is typically vasovagal syncope related to exaggerated orthostatic cardiovascular responses attributed to a hyper-reactive autonomic nervous system. In the present report, a 34 yo male presents to the hospital emergency department (ED) for a sudden loss of consciousness and fall ultimately related to cardiac syncope ascribed to chronic recreational marijuana use complicated by coronary vasospasm.
PubMed: 37946711
DOI: 10.29011/2574-7754.101468