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Revista Portuguesa de Cardiologia :... Oct 2023Cardioneuroablation (CNA), a technique based on radiofrequency ablation of cardiac vagal ganglia, was developed to treat recurrent vasovagal syncope (VVS) with a...
INTRODUCTION AND OBJECTIVES
Cardioneuroablation (CNA), a technique based on radiofrequency ablation of cardiac vagal ganglia, was developed to treat recurrent vasovagal syncope (VVS) with a predominant cardioinhibitory component, as an alternative to pacemaker implantation. The aim of our study was to evaluate the safety and success rate of CNA guided by extracardiac vagal stimulation in patients with highly symptomatic cardioinhibitory VVS.
METHODS
Prospective study of patients who underwent anatomically guided CNA at two cardiology centers. All patients had a history of recurrent syncope with a predominant cardioinhibitory component and refractory to conventional measures. Acute success was determined by the absence or significant reduction of cardiac parasympathetic response to extracardiac vagal stimulation. The primary endpoint was the recurrence of syncope during follow-up.
RESULTS
In total, 19 patients (13 males; mean age 37.8±12.9 years) were included. Ablation was acutely successful in all patients. One patient had a convulsive episode after the procedure, which was deemed unrelated to the ablation, requiring admission to intensive care but without sequelae. No other complications occurred. At a mean follow-up of 21.0±13.2 months (range 3-42 months), 17 patients remained free of syncope. The remaining two patients had recurrence of syncope and, despite undergoing a new ablation procedure, required pacemaker implantation during follow-up.
CONCLUSION
Cardioneuroablation, confirmed by extracardiac vagal stimulation, appears to be an effective and safe treatment option for highly symptomatic patients with refractory VVS with a predominant cardioinhibitory component, providing a new potential approach as an alternative to pacemaker implantation.
Topics: Male; Humans; Young Adult; Adult; Middle Aged; Syncope, Vasovagal; Prospective Studies; Heart; Pacemaker, Artificial; Disease Progression
PubMed: 37268266
DOI: 10.1016/j.repc.2023.02.012 -
Journal of the American College of... Feb 2023Long QT syndrome (LQTS) predisposes individuals to arrhythmic syncope or seizure, sudden cardiac arrest, or sudden cardiac death (SCD). Increased physician and public...
BACKGROUND
Long QT syndrome (LQTS) predisposes individuals to arrhythmic syncope or seizure, sudden cardiac arrest, or sudden cardiac death (SCD). Increased physician and public awareness of LQTS-associated warning signs and an increase in electrocardiographic screening programs may contribute to overdiagnosis of LQTS.
OBJECTIVES
This study sought to identify the diagnostic miscues underlying the continued overdiagnosis of LQTS.
METHODS
Electronic medical records were reviewed for patients who arrived with an outside diagnosis of LQTS but were dismissed as having normal findings subsequently. Data were abstracted for details on referral, clinical history, and both cardiologic and genetic test results.
RESULTS
Overall, 290 of 1,841 (16%) patients with original diagnosis of LQTS (174 [60%] female; mean age at first Mayo Clinic evaluation, 22 ± 14 years; mean QTc interval, 427 ± 25 milliseconds) were dismissed as having normal findings. The main cause of LQTS misdiagnosis or overdiagnosis was a prolonged QTc interval secondary to vasovagal syncope (n = 87; 30%), followed by a seemingly positive genetic test result for a variant in 1 of the main LQTS genes (n = 68; 23%) that was ultimately deemed not to be of clinical significance. Furthermore, patients received misdiagnoses because of a positive family history of SCD that was deemed unrelated to LQTS (n = 46; 16%), isolated/transient QT prolongation (n = 44; 15%), or misinterpretation of the QTc interval as a result of inclusion of the U-wave (n = 40, 14%).
CONCLUSIONS
Knowing the 5 main determinants of discordance between a previously rendered diagnosis of LQTS and full diagnostic reversal or removal (vasovagal syncope, "pseudo"-positive genetic test result in LQTS-causative genes, family history of SCD, transient QT prolongation, and misinterpretation of the QTc interval) increases awareness and provides critical guidance to reduce this burden of overdiagnosed LQTS.
Topics: Female; Male; Humans; Syncope, Vasovagal; Long QT Syndrome; Death, Sudden, Cardiac; Heart Arrest; Phenotype; Electrocardiography
PubMed: 36725176
DOI: 10.1016/j.jacc.2022.11.036 -
Internal and Emergency Medicine Jan 2023Vasovagal syncope (VVS) is the most common cause of transient loss of consciousness. Although not associated with mortality, it causes injuries, reduces quality of life,... (Review)
Review
Vasovagal syncope (VVS) is the most common cause of transient loss of consciousness. Although not associated with mortality, it causes injuries, reduces quality of life, and is associated with anxiety and depression. The European and North American cardiac societies recently published syncope clinical practice guidelines. Most patients with VVS do well after specialist evaluation, reassurance and education. Adequate hydration, increased salt intake when not contraindicated, and careful withdrawal of diuretics and specific hypotension-inducing drugs are a reasonable initial strategy. Physical counterpressure maneuvers might be helpful but can be of limited efficacy in older patients and those with short or no prodromes. Orthostatic training lacks long term efficacy and is troubled by non-compliance. Yoga might be helpful, although the biomedical mechanism is unknown. Almost a third of VVS patients continue to faint despite these conservative measures. Metoprolol was not helpful in a pivotal randomized clinical trial. Fludrocortisone and midodrine significantly reduce syncope recurrences with tolerable side effects, when titrated to target doses. Pacing therapy with specialized sensors appears promising in carefully selected population who have not responded conservative measures. Cardioneuroablation may be helpful but has not been studied in a formal clinical trial.
Topics: Humans; Adult; Aged; Syncope, Vasovagal; Quality of Life; Midodrine; Randomized Controlled Trials as Topic
PubMed: 36117230
DOI: 10.1007/s11739-022-03102-w -
Wilderness & Environmental Medicine Jun 2020
Topics: Evidence-Based Medicine; Humans; Mountaineering; Oxygen Consumption; Syncope, Vasovagal; Weightlessness; Wilderness Medicine
PubMed: 32482518
DOI: 10.1016/j.wem.2020.04.004 -
Transfusion Clinique Et Biologique :... May 2023Adverse donor reactions (ADR) are common to occur during the blood donation process. The most common is vasovagal reactions (VVR) and it cause negative impact in the...
Adverse donor reactions (ADR) are common to occur during the blood donation process. The most common is vasovagal reactions (VVR) and it cause negative impact in the donor return rate. The aim of this study is to determine the prevalence of VVR among blood donors and to study its associated factors, at Hospital University Sains Malaysia (USM). This retrospective case-control study was conducted from June 2018, until June 2021. Data was extracted from the blood bank database system and from donor adverse reaction form. Donors who developed adverse donor reactions were chosen and without VVR were chosen at random as controls. A total of 159 donors, out of 35 134 donors were reported to have VVR which resulted in an overall prevalence of 0.45 %. Dizziness or mild VVR were the most frequently observed adverse reactions, accounting for approximately 87/159 (54.7 %) of all adverse reactions. Multiple logistic regression (MLR) analysis showed VVR were significantly associated with age, female gender, first-time donor, and 450 ml volume of blood collected. The prevalence of vasovagal reactions among blood donors in this study was low which was similar to a few previous studies. Although it was low, still it is very important to reduce risks to a minimum so that the donor return rate could be maintained. The information regarding its associated factors can be used to identify high-risk donors to prevent the incidence in the future.
Topics: Humans; Female; Blood Donors; Retrospective Studies; Case-Control Studies; Prevalence; Malaysia; Syncope, Vasovagal; Hospitals, University
PubMed: 36702200
DOI: 10.1016/j.tracli.2023.01.004 -
Global Epidemiology Jun 2024Today, vasovagal syncope is a common problem that has become a significant health and social challenge. The present study investigated the global prevalence of vasovagal... (Review)
Review
BACKGROUND
Today, vasovagal syncope is a common problem that has become a significant health and social challenge. The present study investigated the global prevalence of vasovagal syncope using a systematic review and meta-analysis.Methods: In this systematic review and meta-analysis study, the global prevalence of vasovagal syncope using the keywords Prevalence, Epidemiology, Vasovagal syncope, and Reflex syncope in PubMed, WoS, Scopus, ScienceDirect databases, and Google scholar search engine without time limit until July 20, 2022, was extracted and transferred to the information management software (EndNote). Then the repeated studies were excluded, and researchers evaluated the remaining studies during three stages (i.e., screening, eligibility, and qualitative assessment). The heterogeneity of studies was investigated using the I index, and the analysis of eligible studies was performed using the random effects model.
RESULTS
In the review of 12 studies with a sample size of 36,156 people, the global prevalence of vasovagal syncope was reported as 16.4 (95%CI: 6-37.5), and the study of publication bias in the studies through the Egger test shows the absence of publication bias in the studies.
CONCLUSION
The prevalence reported in the studies shows a high prevalence of vasovagal syncope, which requires serious intervention and preventive, diagnostic, and therapeutic measures. It is necessary for health policymakers to take effective measures in this field.
PubMed: 38283939
DOI: 10.1016/j.gloepi.2024.100136 -
Blood Transfusion = Trasfusione Del... Jul 2022Acute and delayed vasovagal reactions (VVR) are the most frequent adverse reactions (AR) associated with donations. The aim of this study was to provide the data of the...
BACKGROUND
Acute and delayed vasovagal reactions (VVR) are the most frequent adverse reactions (AR) associated with donations. The aim of this study was to provide the data of the Italian donor haemovigilance system and contextualise the VVR data within the international framework, as well as evaluating, among first-time donors, the association of gender and age and the prevalence of VVR compared to other AR.
MATERIALS AND METHODS
The prevalence analysis was performed on VVR and other AR notified to the Italian haemovigilance system from 2016 to 2019. The analysis on the association of gender and age group and VVR prevalence was performed on first-time donations. The definitions and severity of AR were as set out in the 2014 ISBT/IHN international standards.
RESULTS
From 2016 to 2019, 34,519 AR were notified, of which 87.1% were VVR. The overall VVR prevalence was 25.0/10,000 donations and the overall prevalence of other AR was 3.7/10,000 donations. All the estimated prevalences of AR were higher for first-time donations than for regular donations and lower for whole blood than for apheresis donations. No difference was noted between whole blood and apheresis donations for VVR with complications or injuries. The prevalence of AR among first-time donors was higher in females than in males. The prevalence of VVR decreased as donor age increased.
DISCUSSION
The prevalence of VVR related to blood donation was very low and similar to those calculated by other haemovigilance systems. Among first-time donors, the prevalence of AR was higher in females than in males. The higher prevalence of VVR in young donors and a significant decreasing trend by age group confirmed the results reported in the literature. Finally, no trend by age group in first-time donors was observed for other AR to donations.
Topics: Blood Component Removal; Blood Donors; Cross-Sectional Studies; Female; Humans; Male; Prevalence; Syncope, Vasovagal
PubMed: 34694220
DOI: 10.2450/2021.0114-21 -
Transfusion Sep 2022To inform the development of interventions to retain donors following a vasovagal reaction (VVR), the aim of this study is to use the Health Action Process Approach...
BACKGROUND
To inform the development of interventions to retain donors following a vasovagal reaction (VVR), the aim of this study is to use the Health Action Process Approach (HAPA) to identify predictors of intentions to re-donate and actual return behavior among whole blood (WB) and plasma donors who experienced a VVR.
STUDY DESIGN AND METHODS
A total of 1136 WB donors (M = 32.4 ± 12.5 years; 73.4% female) and 1141 plasma donors (M = 36.5 ± 14.4 years; 73.3% female) completed an online survey after experiencing a VVR. Two hierarchical regression analyses were conducted for each donation type. In the first analysis, donation intentions were regressed onto the motivational HAPA constructs and social support. In the second analysis, donor return within 6 months was regressed onto social support, intentions, and the volitional HAPA constructs.
RESULTS
The motivational and social support variables accounted for 47.2% of the variance in intentions to return in WB donors and 15.7% in plasma donors. For both groups, task self-efficacy, positive and negative outcome expectancies, and social support were significant predictors of intentions to return. Intentions and action planning were significant predictors of donor return in both groups, and recovery self-efficacy was significant for plasma only.
CONCLUSION
The HAPA model can provide guidance to blood collection agencies to design phase-specific and individually-focused interventions to retain WB and plasma donors following a VVR.
Topics: Adult; Blood Donors; Female; Humans; Intention; Male; Middle Aged; Motivation; Surveys and Questionnaires; Syncope, Vasovagal; Young Adult
PubMed: 35924722
DOI: 10.1111/trf.17052 -
Neuroscience Bulletin Jun 2020Vasovagal syncope (VVS) and postural tachycardia syndrome (POTS) are the main forms of orthostatic intolerance in pediatrics and both are underlying causes of... (Review)
Review
Vasovagal syncope (VVS) and postural tachycardia syndrome (POTS) are the main forms of orthostatic intolerance in pediatrics and both are underlying causes of neurally-mediated syncope. In recent years, increasing attention has been paid to the management of VVS and POTS in children and adolescents. A number of potential mechanisms are involved in their pathophysiology, but the leading cause of symptoms varies among patients. A few studies thus have focused on the individualized treatment of VVS or POTS based on selected hemodynamic parameters or biomarkers that can predict the therapeutic effect of certain therapies and improve their effectiveness. This review summarizes the latest developments in individualized treatment of VVS and POTS in children and indicates directions for further research in this field.
Topics: Adolescent; Child; Hemodynamics; Humans; Orthostatic Intolerance; Postural Orthostatic Tachycardia Syndrome; Syncope, Vasovagal
PubMed: 32367250
DOI: 10.1007/s12264-020-00497-4 -
Clinical Autonomic Research : Official... Feb 2023Vasovagal syncope (VVS) is a common clinical condition with few effective medical therapies. The study aimed to evaluate the effectiveness of atomoxetine in suppressing... (Clinical Trial)
Clinical Trial Observational Study
OBJECTIVE
Vasovagal syncope (VVS) is a common clinical condition with few effective medical therapies. The study aimed to evaluate the effectiveness of atomoxetine in suppressing syncope in patients with recurrent VVS.
METHODS
This was a retrospective, open-label, observational case series of 12 patients taking atomoxetine for suppression of recurrent vasovagal syncope. We compared syncope frequency in the 1 year before atomoxetine and while subjects were taking atomoxetine. We used novel applications of the Poisson distribution to describe the results as a collection of n = 1 studies.
RESULTS
There were 12 subjects, eight female, with a mean age 47 ± 22 years and a mean Calgary Syncope Symptom Score of 2 (diagnostic of vasovagal syncope). The patients received a mean dose of atomoxetine of 66 ± 16 mg (1.06 ± 0.21 mg/kg). The mean follow-up period was 1.21 ± 1.01 years. While taking atomoxetine, 11/12 patients appeared to improve and 7/12 had no syncope in follow-up (p = 0.0046). The annualized syncope frequency decreased from a median 5.5 (IQR 4, 6.75) syncope per year to 0 (IQR 0, 0.88) syncope per year (p = 0.002, Wilcoxon rank-sum test). According to the Poisson distribution, 7/12 subjects significantly improved with p values of < 0.0001 to 0.0235, 3/12 did not faint but had too brief follow-up times to detect significance, and 2/12 did not improve significantly.
CONCLUSIONS
In this case series, atomoxetine was a promising oral agent for the prevention of vasovagal syncope. The Poisson distribution permits individual patient-level assessment of improvement and detects insufficient follow-up despite apparent improvement.
Topics: Adult; Aged; Female; Humans; Middle Aged; Atomoxetine Hydrochloride; Retrospective Studies; Syncope; Syncope, Vasovagal; Tilt-Table Test
PubMed: 36401665
DOI: 10.1007/s10286-022-00905-x