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Current Opinion in Cardiology Jan 2002Patients with frequent vasovagal syncope have a poor quality of life and often resist treatment with standard pharmacologic approaches. Although the evidence is weak,... (Review)
Review
Patients with frequent vasovagal syncope have a poor quality of life and often resist treatment with standard pharmacologic approaches. Although the evidence is weak, clinical vasovagal syncope is probably associated with some degree of bradycardia. Studies of temporary pacing during tilt table tests showed that pacing prevented syncope in a little over half of patients who developed a vasovagal response. Six open-label studies of permanent pacing show that permanent pacemaker therapy is associated with substantial improvement over medical therapy. The roles of specific pacemaker modes have not been determined, although there is some evidence that rate-drop responsiveness helps. The second Vasovagal Pacemaker Study will quantify the true benefits of pacing for vasovagal syncope and assess the role of rate-drop response algorithms.
Topics: Bradycardia; Cardiac Pacing, Artificial; Heart Rate; Humans; North America; Patient Selection; Randomized Controlled Trials as Topic; Sensory Thresholds; Syncope, Vasovagal
PubMed: 11790939
DOI: 10.1097/00001573-200201000-00013 -
Current Cardiology Reports Dec 2023Vasovagal syncope (VVS) is a common entity causing transient loss of consciousness and affecting quality of life. Guideline-recommended therapy involves conservative... (Review)
Review
PURPOSE OF REVIEW
Vasovagal syncope (VVS) is a common entity causing transient loss of consciousness and affecting quality of life. Guideline-recommended therapy involves conservative measures and pacing in selected patients. Cardioneuroablation (CNA) targeting the ganglionated plexi in the heart has been shown to reduce excessive vagal excitation, which plays a major role in the pathophysiology of VVS and functional bradycardia.
RECENT FINDINGS
The introduction of CNA has fueled research into its value for the treatment of VVS. Multiple observational studies and one randomized trial have demonstrated the safety and efficacy of CNA and the positive impact on quality of life. This review describes the rationale and CNA procedural techniques and outcomes. Patient selection and future directions have also been described. Cardioneuroablation is a promising treatment for patients with recurrent VVS and functional bradycardia. Further large-scale randomized studies are needed to further verify the safety and efficacy of this approach.
Topics: Humans; Bradycardia; Syncope, Vasovagal; Quality of Life; Heart
PubMed: 37982935
DOI: 10.1007/s11886-023-01997-1 -
Clinical Autonomic Research : Official... Aug 2017Many observations suggest that typical (emotional or orthostatic) vasovagal syncope (VVS) is not a disease, but rather a manifestation of a non-pathological trait. Some... (Review)
Review
Many observations suggest that typical (emotional or orthostatic) vasovagal syncope (VVS) is not a disease, but rather a manifestation of a non-pathological trait. Some authors have hypothesized this type of syncope as a "defense mechanism" for the organism and a few theories have been postulated. Under the human violent conflicts theory, the VVS evolved during the Paleolithic era only in the human lineage. In this evolutionary period, a predominant cause of death was wounding by a sharp object. This theory could explain the occurrence of emotional VVS, but not of the orthostatic one. The clot production theory suggests that the vasovagal reflex is a defense mechanism against hemorrhage in mammals. This theory could explain orthostatic VVS, but not emotional VVS. The brain self-preservation theory is mainly based on the observation that during tilt testing a decrease in cerebral blood flow often precedes the drop in blood pressure and heart rate. The faint causes the body to take on a gravitationally neutral position, and thereby provides a better chance of restoring brain blood supply. However, a decrease in cerebral blood flow has not been demonstrated during negative emotions, which trigger emotional VVS. Under the heart defense theory, the vasovagal reflex seems to be a protective mechanism against sympathetic overactivity and the heart is the most vulnerable organ during this condition. This appears to be the only unifying theory able to explain the occurrence of the vasovagal reflex and its associated selective advantage, during both orthostatic and emotional stress.
Topics: Autonomic Nervous System Diseases; Bradycardia; Heart; Humans; Syncope, Vasovagal; Tilt-Table Test
PubMed: 28669087
DOI: 10.1007/s10286-017-0446-2 -
Polski Merkuriusz Lekarski : Organ... Nov 2016Patients with syncope, without presence of a structural or primary electrical disease, have a very good prognosis. On the other hand, recurring syncope has a negative... (Review)
Review
Patients with syncope, without presence of a structural or primary electrical disease, have a very good prognosis. On the other hand, recurring syncope has a negative impact on quality of life and involves a real risk of physical injuries. Vasovagal syncope usually requires no medical therapy and the most commonly recommended instruction include avoidance of fainting triggers, exercise that mainly provoke leg muscles tension, increase salt consumption and drink indicated amount of fluids. In the case cardioinhibitory type of vasovagal syncope the pacemaker implantation can consider. Unfortunately, not all patients benefit from this treatment. Medical society clearly highlights that proper qualification of VVS patients is the most important factor for cardiostimulator implantation. This article aims to summarize the most important research and guidelines concerning cardiac pacing for patients with vasovagal syncope.
Topics: Cardiac Pacing, Artificial; Humans; Practice Guidelines as Topic; Prognosis; Syncope, Vasovagal
PubMed: 27883352
DOI: No ID Found -
Autonomic Neuroscience : Basic &... Sep 2014The ECG registration during syncope allows physicians either to confirm or exclude an arrhythmia as the mechanism of syncope. Implantable loop recorders have an... (Review)
Review
The ECG registration during syncope allows physicians either to confirm or exclude an arrhythmia as the mechanism of syncope. Implantable loop recorders have an over-writeable memory buffer that continuously records and deletes the patient's ECG for up to three years. Many studies have analyzed the utility of implantable loop recorders in recurrent unexplained or high risk syncope. These studies suggest that early use of the ILR provides more and earlier diagnoses and could help in selecting patients with vasovagal syncope and prolonged asystolic pauses who might benefit from pacemaker therapy. However many questions remain, including its performance in the community by physicians with a range of experience in diagnosing syncope. Furthermore there is no evidence that the use of the ILR changes outcome. Numerous attempts have been made to determine whether patients with predominantly cardioinhibitory syncope benefit from permanent pacemakers, especially if symptoms are frequent and debilitating. While the first open label trials of pacemakers in the treatment of vasovagal syncope showed promising results, this effect has not been confirmed by blinded randomized clinical trials. More recent data seem to suggest that patients over 40years with severe asystolic vasovagal syncope might benefit from permanent pacemakers.
Topics: Cardiac Pacing, Artificial; Humans; Pacemaker, Artificial; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Syncope, Vasovagal
PubMed: 24916847
DOI: 10.1016/j.autneu.2014.05.012 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2007Although vasovagal syncope is the most frequent cause of loss of consciousness, the ability of diagnostic and therapy is still weak. The most important diagnostic method... (Review)
Review
Although vasovagal syncope is the most frequent cause of loss of consciousness, the ability of diagnostic and therapy is still weak. The most important diagnostic method in vasovagal syndrome is the tilt test. The number of clinical trials of the effective treatment of vasovagal syncope is still small. This article attempts to summarize the most important clinical problems connected with vasovagal syncope and includes present guidelines of European Society of Cardiology. The treatment of vasovagal syndrome is mainly based on tilt training and non-pharmacological methods. Presently, there is a lack of evidence for the efficiency of pharmacological treatment. Cardiac pacing should be limited as a choice to a very small group of patients affected by severe cardioinhibitory type of vasovagal syndrome.
Topics: Clinical Trials as Topic; Humans; Practice Guidelines as Topic; Syncope, Vasovagal; Tilt-Table Test
PubMed: 17726870
DOI: No ID Found -
Clinical Autonomic Research : Official... Feb 2022
Topics: Humans; Sleep; Syncope; Syncope, Vasovagal; Tilt-Table Test; Wakefulness
PubMed: 35015169
DOI: 10.1007/s10286-021-00847-w -
High Blood Pressure & Cardiovascular... Aug 2019Syncope is a temporary loss of consciousness due to transient global cerebral hypoperfusion. Reflex syncope is the most frequent, representing 21% of all types of... (Review)
Review
Syncope is a temporary loss of consciousness due to transient global cerebral hypoperfusion. Reflex syncope is the most frequent, representing 21% of all types of syncopal events, and includes: (a) the vasovagal syncope (classical type); (b) the situational syncope; (c) the carotid sinus syncope and (d) non-classical forms. An accurate anamnesis and physical examination are fundamental for the diagnosis. Although limited evidence is available regarding the efficacy of some treatments, a number of these can be successfully used in the clinical practice. It is, however, important to personalize the therapeutic approach in order to achieve an efficient reduction or suppression of syncopal episodes. Patients should be reassured about the benignity of these events and the possibility of reducing their frequency over time. They should be also educated on how to recognize and abort incoming syncopal episodes. Patients may be advised to increase their introit in water and salt, as well as to reduce vasoactive medications, if no contraindications exist. Orthostatic training may be beneficial but only in very motivated young patients capable of strictly adhering to the exercise plan. So far, any proposed pharmacological treatment has demonstrated very limited efficacy and, therefore, it should be tried in case of failure of non-pharmacological approaches. Pacemaker implantation is clearly indicated in patients with documented cardioinhibitory syncope in the absence of a vasodepressor component, which can compromise their quality of life. Despite the American and European guidelines for the treatment of syncope are similar, still some differences can be denoted. Aim of this study is to evaluate the management of patients with recurrent syncopal episodes focusing on pharmacological and non-pharmacological approaches.
Topics: Blood Pressure; Cerebrovascular Circulation; Clinical Decision-Making; Consciousness; Humans; Practice Guidelines as Topic; Recurrence; Risk Factors; Syncope, Vasovagal; Treatment Outcome
PubMed: 31297720
DOI: 10.1007/s40292-019-00327-3 -
Clinical Autonomic Research : Official... Aug 2007
Review
Topics: Diagnosis, Differential; Humans; Syncope, Vasovagal; Ventricular Fibrillation
PubMed: 17665091
DOI: 10.1007/s10286-007-0432-1 -
Physiology & Behavior Sep 2021It has been suggested that vertebrate freezing and tonic immobility (TI) represent the antecedents of human emotional vasovagal syncope. When a prey detects an... (Review)
Review
It has been suggested that vertebrate freezing and tonic immobility (TI) represent the antecedents of human emotional vasovagal syncope. When a prey detects an approaching predator, it suddenly interrupts its ongoing activity and behaves according to the predator's distance. A prey enters TI when the fight or flight reaction is not feasible and the animal is captured. TI is defined as a post-contact, all or none, innate immobility reflex response that persists after the end of the prey-predator contact. In humans, vasovagal syncope, a reversible adaptive response frequently associated with fainting, occurs in response to emergency conditions such as strong emotions, orthostatic stress, anoxia, visceral pain and decrease in blood volume. The aim of the present review is to dispute the hypothesis that human vasovagal syncope represents the evolution of the bradycardia observed during freezing in a prey-predator condition in other vertebrates. The hypothesis does not take into account three crucial issues: 1) freezing and TI are defence responses which differ from each other in behavioural, cardiovascular and neurophysiological correlates; 2) the initial phase of vasovagal syncope is associated with tachycardia, whereas freezing is associated with a sudden fast-developing bradycardia; 3) the second phase of vasovagal syncope terminates with a blood pressure collapse, whereas blood pressure levels remain at basal levels during both freezing and TI.
Topics: Animals; Bradycardia; Emotions; Freezing; Humans; Syncope; Syncope, Vasovagal
PubMed: 34023376
DOI: 10.1016/j.physbeh.2021.113463