Paroxetine was found to significantly improve the symptoms of patients with vasovagal syncope unresponsive to or intolerant of traditional medications and was well tolerated by patients.

Orthostatic training was found to significantly improve symptoms of adolescents with neurocardiogenic syncope unresponsive to or intolerant of traditional medications. Twice-a-day training sessions of 40 minutes were well accepted by patients.

The incidence of atrial fibrillation (AF) in cryptogenic stroke (CS) patients has been studied in carefully controlled clinical trials, but real-world data are limited. We investigated the incidence of AF in clinical practice among CS patients with an insertable cardiac monitor (ICM) placed for AF detection. Patients with CS admitted to our Stroke Unit were included in the study; they received an ICM and were monitored for up to 3 years for AF detection. All detected AF episodes of at least 120 sec were considered. From March 2016 to March 2019, 58 patients (mean age 68.1 ± 9.3 years, 67% male) received an ICM to detect AF after a CS. No patients were lost to follow-up. AF was detected in 24 patients (41%, AF group mean age 70.8 ± 9.4 years, 62% male) after a mean time of 6 months from ICM (ranging from 2 days to 2 years) and 8 months after CS (ranging from 1 month to 2 years). In these AF patients, anticoagulant treatment was prescribed and nobody had a further stroke. In conclusion, AF episodes were detected via continuous monitoring with ICMs in 41% of implanted CS patients. AF in CS patients is asymptomatic and difficult to diagnose by strategies based on intermittent short-term recordings. Therefore, we suggest that ICMs should be part of daily practice in the evaluation of CS patients. In 20-40% of ischemic strokes, a definitive cause is not identified, despite extensive evaluation 1 ; this condition has been defined as "cryptogenic stroke" (CS) 1-6. Many hypotheses have arisen to find an explanation for the stroke occurrence, but there is no consensus 7. Atrial fibrillation (AF) is a well-known cause of ischemic stroke and about 15% of strokes are attributable to a documented AF 8,9. Moreover, AF is the most common cause of cardioembolism in patients older than 70 10,11. Unfortunately, AF can evade conventional monitoring strategies of patients with acute cerebral ischemia, thus supporting its possible role in CS 12. The diagnosis of AF has clinical relevance, as randomized clinical trials have shown that anticoagulation reduces the risk of stroke in patients with AF 13,14. However, it is required to document AF to initiate anticoagulant therapy after ischemic stroke and, in the absence of documented AF, antiplatelet agents are recommended 15. A diagnosis of AF can influence the management of CS, because the presence of AF changes the pharmacological therapy to anticoagulant prescription. Indeed, it has been shown that anticoagulation is superior than antiaggregation in preventing further strokes in patients with AF 16. The risk of stroke in patients with AF can be estimated by the CHA 2 DS 2-VASc score 17 , but, even in the presence of strong suspicion, AF may not be detected in the acute phase of ischemic stroke, due to its paroxysmal and asymptomatic nature 18-21. For this reason, many strategies have been explored to improve detection of AF, ranging from in-hospital monitoring, serial electrocardiography and Holter monitoring and the use of external events (or loop recorders) or insertable cardiac moni...

In addition to PVI, stepwise ablation achieving sinus rhythm and nonatrial arrhythmia inducibility has relevantly improved the clinical outcome of the PAF control strategy.

BACKGROUND Patients with atrial fibrillation (AF) often have sleep apnea (SA), but diagnosis of SA with polysomnography is costly. SA monitoring is a pacemaker feature that measures respiratory disturbance index, the sum of abnormal respiratory events divided by sleep duration. OBJECTIVE The purpose of this study was to evaluate the incidence and severity of SA and its association with AF in an unselected population fitted with pacemakers. METHODS RESPIRE (REgistry of Sleep APnea monItoring and Atrial Fibrillation in pacemakeR patients) was a multicenter, international, observational, open-label study following adult subjects for 18 months after implantation with an SA monitoring-enabled dual-chamber pacemaker. Severe SA was defined as average respiratory disturbance index 20 from implantation to follow-up visit. The first co-primary end point was the difference in significant AF (cumulative AF episodes lasting 24 hours over 2 consecutive days) between subjects with severe and those nonsevere SA at 12 months in the full analysis set (N 5 553). The second co-primary end point was the rate of major serious adverse events at 18 months in the modified intention-to-treat set (N 5 1024). RESULTS Severe SA was detected in 31.1% (172 of 553). A higher incidence of significant AF was reported in patients with severe SA than in patients with nonsevere SA (25.0% vs 13.9%; difference 11.1%; 95% confidence interval 3.7%-18.4%; P 5 .002). Significant AF increased with time in both groups, but at a faster rate in the severe SA group. No intergroup difference in the overall rate of major serious adverse events was observed (P 5 .065). CONCLUSION SA screening over 12 months identified severe SA in almost one-third of unselected patients fitted with pacemakers. Severe SA was associated with a higher incidence of significant AF.