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Autonomic Neuroscience : Basic &... Feb 2024Vasovagal syncope (VVS) is a prevalent condition characterized by a sudden drop in blood pressure and heart rate, leading to a brief loss of consciousness and postural... (Meta-Analysis)
Meta-Analysis
The efficacy of non-pharmacological and non-pacing therapies in preventing vasovagal syncope: Tilt training, physical counter pressure maneuvers, and yoga - A systematic review and meta-analysis.
BACKGROUND
Vasovagal syncope (VVS) is a prevalent condition characterized by a sudden drop in blood pressure and heart rate, leading to a brief loss of consciousness and postural control. Recurrent episodes of VVS significantly impact the quality of life and are a common reason for emergency department visits. Non-pharmacological interventions, such as tilt training, physical counter pressure maneuvers, and yoga, have been proposed as potential treatments for VVS. However, their efficacy in preventing VVS remains uncertain.
METHODS
A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Web of Science, and Embase were searched up to March 2023 for randomized controlled trials comparing non-pharmacological interventions with control in preventing VVS recurrence. The primary outcome was the recurrence rate of VVS episodes.
RESULTS
A total of 1130 participants from 18 studies were included in the meta-analysis. The overall mean effect size for non-pharmacological interventions versus control was 0.245 (95 % CI: 0.128-0.471, p-value <0.001). Subgroup analysis showed that yoga had the largest effect size (odds ratio 0.068, 95 % CI: 0.018-0.250), while tilt training had the lowest effect size (odds ratio 0.402, 95 % CI: 0.171-0.946) compared to control. Physical counter pressure maneuvers demonstrated an odds ratio of 0.294 (95 % CI: 0.165-0.524) compared to control.
CONCLUSION
Non-pharmacological interventions show promise in preventing recurrent VVS episodes. Yoga, physical counter pressure maneuvers, and tilt training can be considered as viable treatment options. Further research, including randomized studies comparing pharmacological and non-pharmacological approaches, is needed to evaluate the safety and efficacy of these interventions for VVS treatment.
Topics: Humans; Tilt-Table Test; Yoga; Syncope, Vasovagal; Quality of Life; Blood Pressure
PubMed: 38181551
DOI: 10.1016/j.autneu.2023.103144 -
Europace : European Pacing,... Apr 2009Knowledge on the aetiology of vasovagal syncope (VVS) is of great importance to optimize its diagnostic and therapeutic options. To unravel the largely unknown... (Review)
Review
Knowledge on the aetiology of vasovagal syncope (VVS) is of great importance to optimize its diagnostic and therapeutic options. To unravel the largely unknown pathophysiology, studies on genetic aspects of VVS can be of use. This systematic review on all available literature aims to provide an overview of the current knowledge of VVS genetics. The MEDLINE and EMBASE database were systematically searched for all studies discussing genetic factors as a cause of VVS. Hereditary aspects of VVS were studied in 19 studies. Six studies determined a positive family history in, respectively, 19-90% of the VVS patients. These numbers, however, are not higher than the cumulative incidence of VVS in the general population (35-39%). Four studies examined potential genetic polymorphisms associated with VVS. Only a Gly389 allele was more frequently present in VVS patients with a positive HUT test, although the significance level was set much higher than usual in genetic studies, and this result has not been replicated so far. Knowledge on genetic aspects of VVS could be very useful in clinical practice and research, but the current evidence that it has a genetic basis is not very strong.
Topics: Alleles; Cluster Analysis; Genetic Linkage; Humans; Polymorphism, Genetic; Syncope, Vasovagal
PubMed: 19153089
DOI: 10.1093/europace/eun387 -
American Journal of Therapeutics
Meta-Analysis
Topics: Humans; Midodrine; Syncope, Vasovagal
PubMed: 35703495
DOI: 10.1097/MJT.0000000000001513 -
L'Encephale Oct 2013Seventy-five percent of patients with blood-injection-injury phobia (BII-phobia) report a history of fainting in response to phobic stimuli. This specificity may lead to... (Comparative Study)
Comparative Study Review
INTRODUCTION
Seventy-five percent of patients with blood-injection-injury phobia (BII-phobia) report a history of fainting in response to phobic stimuli. This specificity may lead to medical conditions remaining undiagnosed and untreated, incurring considerable cost for the individual and society. The psychophysiology of BII-phobia remains poorly understood and the literature on effective treatments has been fairly sparse. Aims of the systematic review: to synthesize the psychophysiology of BII-phobia and to propose a systematic review of the literature on effectiveness of different treatments evaluated in this indication.
RESULTS
Firstly, the most distinct feature of the psychophysiology of BII-phobia is its culmination in a vasovagal syncope, which has been described as biphasic. The initial phase involves a sympathetic activation as is typically expected from fear responses of the fight-flight type. The second phase is characterized by a parasympathetic activation leading to fainting, which is associated with disgust. Subjects with syncope related to BII-phobia have an underlying autonomic dysregulation predisposing them to neurally mediated syncope, even in the absence of any blood or injury stimulus. Many studies report that BII-phobic individuals have a higher level of disgust sensitivity than individuals without any phobia. Secondly, behavioral psychotherapy techniques such as exposure only, applied relaxation, applied tension, and tension only, have demonstrated efficacy with no significant difference between all these techniques. The disgust induction has not improved effectiveness of exposure.
CONCLUSION
We have explained the psychophysiology of BII-phobia, the understanding of which is required to study and validate specific techniques, in order to improve the prognosis of this disorder, which is a public health issue.
Topics: Accidents; Arousal; Blood; Clinical Trials as Topic; Cognitive Behavioral Therapy; Diagnosis, Differential; Fear; Humans; Injections; Phobic Disorders; Prognosis; Psychophysiology; Relaxation Therapy; Syncope, Vasovagal; Wounds and Injuries
PubMed: 23095595
DOI: 10.1016/j.encep.2012.06.031 -
Prehospital Emergency Care 2020Syncope is a common condition that may be prevented. There are non-pharmacological interventions that may be of benefit during the acute episode preceding syncope...
Syncope is a common condition that may be prevented. There are non-pharmacological interventions that may be of benefit during the acute episode preceding syncope (presyncope), including physical counter-pressure maneuvers (PCM) or change of body position. We performed a systematic review of interventions that may be applied during presyncope as an immediate, first aid tactic. We searched Medline, Embase, and CINAHL and used the Grading of Recommendations Assessment, Development and Evaluation methods, and risk of bias assessments to determine the certainty of the evidence. We included randomized controlled trials (RCTs), non-randomized studies, and case series investigating adults and children with signs and symptoms of presyncope of suspected vasovagal or orthostatic origin who applied any intervention that could be used as an immediate, first aid intervention. We examined the following outcomes: prevention of syncope, adverse events, symptom improvement, and vital signs. We conducted a sub-group analysis based on the etiology of vasovagal or orthostatic presyncope. We screened 5,160 titles and abstracts followed by 81 full text articles. We identified 8 studies meeting inclusion criteria, including 2 RCTs and 6 observational studies. All studies used PCM in adults and all were judged to be of low and very low certainty of evidence. For prevention of syncope, one RCT demonstrated benefit with the use of PCM (RR = 1.80 [1.26-1.89]), while observational studies failed to show benefit (RR = 1.31 [0.98 - 1.75]). Two RCTs showed benefit in symptom improvement (RR = 6.00 [2.21 - 8.61] and (RR = 1.57 [1.06 - 1.93]). Blood pressure (BP) improved with the use of PCM: systolic BP mean difference (MD) 21 mmHg higher (95% CI: 18.25 to 23.41 BPM) and diastolic BP MD 11 mmHg higher (95% CI: 9.39 to 13.10 mmHg higher). No adverse events were reported. While there is a minimal amount of evidence available and the findings were mixed, PCM may provide benefit for prevention of syncope during acute episodes of presyncope and may be tried in the first aid setting. No evidence was found for other non-pharmacologic interventions or for the use of PCM in children.
Topics: Adolescent; Adult; Aged; Blood Pressure; Child; Emergency Medical Services; Humans; Middle Aged; Syncope; Young Adult
PubMed: 30957664
DOI: 10.1080/10903127.2019.1605431 -
European Journal of Obstetrics,... Sep 2020To investigate the effect of the vaginoscopic approach to office hysteroscopy on patients' experience of pain, when compared with the traditional approach where a... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate the effect of the vaginoscopic approach to office hysteroscopy on patients' experience of pain, when compared with the traditional approach where a vaginal speculum is used.
METHODS
Medline, Embase, CINAHL and the Cochrane library were searched from inception until December 2019, in order to perform a systematic review and meta-analysis of all randomised controlled trials investigating vaginoscopy compared to traditional hysteroscopy on pain experienced by women undergoing diagnostic or operative hysteroscopy in an office setting. Data regarding procedural time, feasibility, incidence of vasovagal reactions and complications, acceptability and satisfaction were also recorded.
RESULTS
The literature search returned 363 results of which seven were selected for systematic review, and six for meta-analysis. The vaginoscopic approach was associated with a statistically significant reduction in pain (4 studies including 2214 patients; SMD -0.27, 95 % CI -0.48 to -0.06), procedural time (6 studies including 2443 patients; SMD -0.25, 95 % CI -0.43 to -0.08) and the incidence of vasovagal episodes (3 studies including 2127 patients; OR 0.35; 95 % CI 0.15 to 0.82). Failure rates between the two techniques were similar (p = .90). No study reported significant differences in complications or patient or clinician acceptability or satisfaction.
CONCLUSION
Clinicians performing office hysteroscopy should use the vaginoscopic technique because it makes office hysteroscopy quicker, less painful and reduces the likelihood of inducing a vasovagal reaction. The traditional approach should only be used when vaginoscopy fails or when the need for cervical dilatation is anticipated.
Topics: Female; Humans; Hysteroscopy; Laparoscopy; Pain; Pain Measurement; Pregnancy; Vagina
PubMed: 32645643
DOI: 10.1016/j.ejogrb.2020.06.045 -
Transfusion Jun 2021Knowledge translation focuses on the transfer of research findings into policy and practice. To provide insight into the state of knowledge translation in blood donor...
BACKGROUND
Knowledge translation focuses on the transfer of research findings into policy and practice. To provide insight into the state of knowledge translation in blood donor research, we undertook a rapid review of a key research area in the field with high potential for translation, vasovagal reactions (VVRs). We examined the number and nature of VVR-related studies to determine the availability of research evidence, and mapped the included articles along the research-to-practice trajectory using the Knowledge to Action framework.
STUDY DESIGN AND METHODS
PubMed, PsycINFO, CINAHL, and EMBASE were searched for peer-reviewed journal articles from inception to October 2019 using the terms blood don* AND vasovagal OR faint* OR syncope.
RESULTS
A total of 176 articles met our inclusion criteria. Studies relating to VVRs increased substantially from 1942 to 2019, with 84% published in the last 20 years. Articles were predominately observation (non-intervention) studies (117; 66%), followed by intervention (knowledge inquiry) studies (31; 18%) and review (knowledge synthesis) studies (20; 11%). The evidence from intervention research was limited, with 14 strategies tested in 31 studies and often by the same research groups. Only 5 (3%) implementation and evaluation studies were found; all focused on evaluating the effects of a newly introduced intervention on VVR rates through uncontrolled or cross-sectional study designs.
DISCUSSION
VVR research is in the early stages of knowledge translation. More intervention research is needed to provide a robust evidence base as well as more published implementation research to share knowledge of translating research into policy and practice.
Topics: Blood Donors; Humans; Risk Factors; Syncope, Vasovagal; Translational Research, Biomedical
PubMed: 33797069
DOI: 10.1111/trf.16391 -
Journal of Interventional Cardiac... Jun 2019A proportion of patients with vasovagal syncope (VVS) experience recurrence despite appropriate management. Closed loop stimulation (CLS) pacing is a promising treatment... (Meta-Analysis)
Meta-Analysis
PURPOSE
A proportion of patients with vasovagal syncope (VVS) experience recurrence despite appropriate management. Closed loop stimulation (CLS) pacing is a promising treatment for a subgroup of patients with cardioinhibitory response on head-up tilt table test (HUTT). Nonetheless, its efficacy remains uncertain. We sought to assess the efficacy of CLS pacing in patients with cardioinhibitory VVS.
METHODS
We searched PubMed, Google Scholar, and the Cochrane Central Register of controlled trials for relevant studies (last search date April 23, 2018). Data were pooled using the Mantel-Haenszel fixed-effects model. For cohort studies, we used a Freeman-Tukey transformation to calculate the weighted summary proportion. Primary outcomes are syncope and presyncope.
RESULTS
Eight studies were included in the final analyses (two single-blinded and one double-blinded RCT, two prospective observational studies, and three retrospective observational studies). Two hundred ninety-one patients included, with an average age of 57 years. Quality of evidence is moderate. Use of CLS pacing was associated with reduced risk of syncope (OR 0.08; 95% CI 0.03-0.18; I 32%) and presyncope (OR 0.34; 95% CI 0.18-0.63; I 0.00%). Using proportion meta-analysis, the summary estimate of the proportion of cases that developed syncope during CLS pacing was similar between RCTs and prospective studies (3.2% and 3.1%), respectively. This is much lower than the rate of recurrence in the control arm of RCTs at 33.7%. Sensitivity analyses yielded similar results.
CONCLUSION
CLS pacing is beneficial for patients with recurrent vasovagal syncope who demonstrate a cardioinhibitory response on HUTT.
Topics: Cardiac Pacing, Artificial; Humans; Recurrence; Syncope, Vasovagal; Tilt-Table Test
PubMed: 30863907
DOI: 10.1007/s10840-019-00531-0 -
Diagnostics (Basel, Switzerland) Nov 2023The objective of this study was to compare the outcomes of the ultrasound- and fluoroscopy-guided techniques in the management of back pain. Using PubMed, Scopus, and... (Review)
Review
The objective of this study was to compare the outcomes of the ultrasound- and fluoroscopy-guided techniques in the management of back pain. Using PubMed, Scopus, and the Cochrane Library, we searched randomized controlled trials (RCTs) published before May 2023, which reported relevant data on the topic. The effectiveness of the ultrasound-guided (US-guided) and fluoroscopy-guided (FL-guided) approaches for back pain management was compared in terms of postoperative pain intensity, postoperative functional outcomes, and postoperative complications. Subgroup analyses were conducted for different postoperative periods. Eight studies were included in the analysis. There was no significant difference in post-procedural pain relief at one week, two weeks, one month, two months, and three months between the US-guided and FL-guided interventions for back pain management (SMD with 95% CI is -0.01 [-0.11, 0.10]), = 0.91, I = 0%). In terms of the postoperative functional outcomes assessed by the "Oswestry Disability Index" (ODI) functionality score, the model tends to favor the FL-guided injections over the US-guided injections (SMD with 95% CI: 0.13 [-0.00, 0.25], = 0.05, I = 0). Finally, the US-guided and FL-guided injections did not show significantly different results in terms of postoperative complications (RR with 95% CI is 0.99 [0.49, 1.99], = 0.97, I = 0). The subgroup analysis also did not demonstrate differences between the US-guided and FL-guided techniques in the following outcomes: vasovagal reaction, transient headache, and facial flushing. There was no significant difference between the US-guided and FL-guided injections for treating back pain in terms of postoperative pain intensity and complications. Still, the model tends to favor the FL-guided injections over the US-guided injections in terms of functionality.
PubMed: 37998610
DOI: 10.3390/diagnostics13223474 -
The Canadian Journal of Cardiology Jan 2021Drivers at risk of sudden incapacitation from syncope pose a potential threat to themselves and to society. The purpose of this systematic review is to synthesize the...
BACKGROUND
Drivers at risk of sudden incapacitation from syncope pose a potential threat to themselves and to society. The purpose of this systematic review is to synthesize the risk of motor vehicle collisions (MVCs) for patients with a history of syncope.
METHODS
We systematically searched Medline (1946-2019) as well as Cinahl, Embase, Psychinfo, and the Transportation Research Information Documentation (1806-2017) for articles on MVCs and drivers with vasovagal syncope (VVS), arrhythmic syncope, or syncope not yet diagnosed (NYD). Quality ratings were assigned by team consensus.
RESULTS
Eleven studies of moderate quality were included (n = 42,972). Compared with the general populations of Canada, the United States, and the United Kingdom (0.49%-2.29% per driver-year), the prospective MVC risk was lower for VVS (0.0%-0.31% per driver-year; 3 studies; n = 782) and higher for arrhythmic syncope (1.9%-3.4% per driver-year; 2 studies; n = 730). The results were more variable for syncope NYD (0.0%-6.9% per driver-year prospectively; 6 studies; n = 41,460). Patients with syncope NYD had an almost 2-fold increased MVC risk in the largest study, although the smaller studies showed contradictory findings.
CONCLUSIONS
VVS patients appear to be at very low risk for MVCs, supporting current guidelines which do not recommend driving suspension for these patients in most cases. Although the data for other forms of syncope are too limited for definitive conclusions and must be improved, arrhythmic syncope appears to be associated with nontrivial risk.
Topics: Accidents, Traffic; Humans; Risk Assessment; Syncope
PubMed: 32504546
DOI: 10.1016/j.cjca.2020.02.070