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JAMA Internal Medicine Jun 2021
Topics: Humans; Syncope, Vasovagal
PubMed: 33587095
DOI: 10.1001/jamainternmed.2020.9151 -
Pacing and Clinical Electrophysiology :... Dec 2021Vasovagal syncope (VVS) (or neurocardiogenic syncope) is a common clinical condition that is challenging to both physicians and patients alike. Severe episodes of... (Review)
Review
Vasovagal syncope (VVS) (or neurocardiogenic syncope) is a common clinical condition that is challenging to both physicians and patients alike. Severe episodes of recurrent syncope can result in physical injury as well as psychological distress. This article provides a brief overview of current management strategies and a detailed overview of therapeutic modalities such as closed loop stimulation (CLS) and cardioneuroablation (CNA).
Topics: Ablation Techniques; Algorithms; Cardiac Pacing, Artificial; Diagnosis, Differential; Humans; Quality of Life; Syncope, Vasovagal
PubMed: 34748224
DOI: 10.1111/pace.14402 -
Heart Rhythm Jun 2018In part I of this study, we found that the classical studies on vasovagal syncope, conducted in fit young subjects, overstated vasodilatation as the dominant hypotensive... (Review)
Review
In part I of this study, we found that the classical studies on vasovagal syncope, conducted in fit young subjects, overstated vasodilatation as the dominant hypotensive mechanism. Since 1980, blood pressure and cardiac output have been measured continuously using noninvasive methods during tilt, mainly in patients with recurrent syncope, including women and the elderly. This has allowed us to analyze in more detail the complex sequence of hemodynamic changes leading up to syncope in the laboratory. All tilt-sensitive patients appear to progress through 4 phases: (1) early stabilization, (2) circulatory instability, (3) terminal hypotension, and (4) recovery. The physiology responsible for each phase is discussed. Although the order of phases is consistent, the time spent in each phase may vary. In teenagers and young adults, progressive hypotension during phases 2 and 3 can be driven by vasodilatation or falling cardiac output. The fall in cardiac output is secondary to a progressive decrease in stroke volume because blood is pooled in the splanchnic veins. In adults a fall in cardiac output is the dominant hypotensive mechanism because systemic vascular resistance always remains above baseline levels.
Topics: Electrocardiography; Hemodynamics; Humans; Syncope, Vasovagal; Tilt-Table Test
PubMed: 29246828
DOI: 10.1016/j.hrthm.2017.12.013 -
Journal of Cardiovascular... Oct 2022Catheter-based cardioneuroablation is increasingly being utilized to improve outcomes in patients with vasovagal syncope and atrioventricular block due to vagal... (Review)
Review
Catheter-based cardioneuroablation is increasingly being utilized to improve outcomes in patients with vasovagal syncope and atrioventricular block due to vagal hyperactivity. There is now increasing convergence among enthusiasts on its various aspects, including patient selection, technical steps, and procedural end-points. This pragmatic review aims to take the reader through a step-by-step approach to cardioneuroablation: we begin with a brief overview of the anatomy of intrinsic cardiac autonomic nervous system, before focusing on the indications, preprocedure and postprocedure management, necessary equipment, and its potential limitations.
Topics: Atrioventricular Block; Catheter Ablation; Heart; Humans; Syncope, Vasovagal; Vagus Nerve
PubMed: 35362165
DOI: 10.1111/jce.15480 -
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 -
JAMA Internal Medicine Jun 2021
Topics: Humans; Syncope, Vasovagal
PubMed: 33587099
DOI: 10.1001/jamainternmed.2020.9148 -
Internal Medicine (Tokyo, Japan) Jul 2022Coronavirus disease 2019 (COVID-19) has become a pandemic, and vaccines remain the only effective tools available for ending it. However, their side effects, such as...
Coronavirus disease 2019 (COVID-19) has become a pandemic, and vaccines remain the only effective tools available for ending it. However, their side effects, such as syncope, which mimics sudden cardiac death, are serious concerns. We herein report 6 cases of delayed vasovagal syncope and presyncope (VVR) caused by COVID-19 vaccination among 25,530 COVID-19 patients. The prevalence of delayed VVR due to COVID-19 vaccination was 0.026%. In addition, no delayed VVR was found among 17,386 patients who received the influenza vaccine. Delayed VVR is likely to be overlooked if medical staff are not aware of this symptom. This report provides significant information regarding effects of COVID-19 vaccination.
Topics: COVID-19; COVID-19 Vaccines; Humans; Syncope; Syncope, Vasovagal; Vaccination
PubMed: 35569982
DOI: 10.2169/internalmedicine.9318-21 -
Heart Rhythm May 2020The physiological principles underlying pacemaker treatment in patients with vasovagal syncope have never been reviewed. Current knowledge suggests that pacing the right... (Review)
Review
The physiological principles underlying pacemaker treatment in patients with vasovagal syncope have never been reviewed. Current knowledge suggests that pacing the right heart is unlikely to correct blood pressure during a vasovagal reaction. In adults, the reason for this is that stroke volume is dictated by central blood volume contained in the cardiopulmonary vessels within the chest (ie, left ventricular preload). Preceding posture-triggered vasovagal syncope, there is a significant fall in central blood volume and therefore in stroke volume and cardiac output long before the onset of bradycardia. This explains why high rate cardiac pacing does not improve cardiac output or blood pressure during presyncope. Contradictory results between physiological theory and trial evidence underlying pacemaker treatment at present cannot be explained. Placebo effects during pacing for vasovagal syncope should be considered. More work is needed to solve the dilemma.
Topics: Blood Pressure; Cardiac Output; Cardiac Pacing, Artificial; Heart Rate; Humans; Posture; Recurrence; Syncope, Vasovagal; Tilt-Table Test
PubMed: 31561028
DOI: 10.1016/j.hrthm.2019.09.022 -
Annals of Internal Medicine Nov 2000Vasovagal syncope is the most common type of syncope and is one of the most difficult types to manage. (Review)
Review
BACKGROUND
Vasovagal syncope is the most common type of syncope and is one of the most difficult types to manage.
PURPOSE
This article reviews the status of mechanisms, diagnosis, and management of vasovagal syncope.
DATA SOURCES
MEDLINE search for English-language and German-language articles on vasovagal syncope published up to June 1999.
STUDY SELECTION
Case reports and series, clinical trials, research investigations, and review articles from peer-reviewed journals.
DATA EXTRACTION
Findings were summarized and discussed individually. Summaries were made in table format. Statistical analysis of combined data was inappropriate because of differences among studies in patient selection, testing, and follow-up.
DATA SYNTHESIS
The population of patients with vasovagal syncope is highly heterogeneous. Triggers of vasovagal syncope are likely to be protean, and many potential central and peripheral triggers have been identified. The specific mechanisms underlying the interactions among decreased preload, sympathetic and parasympathetic modulation, vasodilation, and cardioinhibition remain unknown. Tilt-table testing is a widely used diagnostic tool. The test results should be interpreted in the context of patients' clinical presentations and with an understanding of the sensitivity and specificity of the test. Assessment of therapeutic outcomes has been difficult, primarily because of patient heterogeneity, the large number of pharmacologic agents available for therapy, and the sporadic nature of the syndrome complex.
CONCLUSIONS
Vasovagal syncope is a common clinical syndrome that has complex and variable mechanisms and is difficult to manage. Advancements are being made in laboratory investigations of its triggering mechanisms. Randomized, controlled trials of pharmacologic and nonpharmacologic interventions are needed. Mechanism-targeted therapeutic trials may improve clinical outcomes.
Topics: Animals; Autonomic Nervous System; Blood Pressure; Humans; Physical Examination; Practice Guidelines as Topic; Reproducibility of Results; Syncope, Vasovagal; Tilt-Table Test; Vagus Nerve
PubMed: 11074905
DOI: 10.7326/0003-4819-133-9-200011070-00014 -
Medicina (Kaunas, Lithuania) Nov 2022Due to technological advancements in miniaturization of instruments and improved optics, the number of office hysteroscopic procedures has increased over time. Office... (Review)
Review
Due to technological advancements in miniaturization of instruments and improved optics, the number of office hysteroscopic procedures has increased over time. Office hysteroscopy is preferred due to avoidance of general anesthesia and decreased overall cost. Vasovagal syncope has been implied as the most common complication. Vasovagal syncope is associated with inappropriate reflex vasodilation and bradycardia in the setting of an acute malfunction between the autonomic nervous system and the cardiovascular system; however, there is no mortality associated with vasovagal syncope. A management strategy for acute vasovagal reflex during office hysteroscopy is proposed in order to manage this common complication.
Topics: Female; Pregnancy; Humans; Syncope, Vasovagal; Hysteroscopy; Autonomic Nervous System; Bradycardia; Hypotension
PubMed: 36422165
DOI: 10.3390/medicina58111626