Brugada syndrome and syncope: A systematic review

Mascia, Giuseppe; Bona, Roberta Della; Ameri, Pietro; Canepa, Marco; Porto, Italo; Brignole, Michele

doi:10.1111/jce.14787

Cited by 26 publications

(25 citation statements)

References 11 publications

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“…Additionally, patients with a LAA thrombus had a noticeably lower median LVEF compared to patients without LAA thrombi, indicating an important role of left ventricular function in patients at a high risk of the formation of LAA thrombi. Further precipitating factors for the development of AF, such as concomitant hyperthyroidism [ 13 ] or the presence of cardiac channelopathies [ 14 , 15 , 16 ], did not show an association with the presence of reduced LAAEV or LAA thrombus in our patient population. Data on additional possible predictors such as endurance sports [ 17 ], alcohol consumption or smoking [ 18 ] was not routinely collected and, therefore, not available for analysis.…”

Section: Discussionmentioning

confidence: 79%

Incidence and Predictors of Left Atrial Appendage Thrombus before Catheter Ablation of Thrombogenic Arrhythmias

Wegner

Radke

Ellermann

et al. 2022

JPM

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Introduction: Transesophageal echocardiography (TEE) is routinely performed before catheter ablation of atrial tachyarrhythmias to rule out the presence of left atrial thrombi. However, data to support this practice are inconsistent. Methods: We analyzed consecutive pre-procedural TEE in a high-volume electrophysiology center for the presence of left atrial thrombi and a relevant flow reduction in the left atrial appendage (LAA) defined as LAA sludge or LAA emptying velocity (LAAEV) < 20 cm/s. The possible predictors of reduced flow were recorded and compared in a multivariate logistic regression analysis. Results: 1676 TEE were included (1122 before pulmonary vein isolation, 436 before atrial flutter ablation, 166 before other ablations). 543 patients (32%) were female and 991 (59%) were on DOAC. Nine patients (0.5%) had an LAA thrombus on pre-procedural TEE. Ninety-five further patients (5.7%) had a relevant reduction in LAA flow. The underlying rhythm showed a significant association with the presence of LAA thrombus or reduced LAA flow (p = 0.003). Patients in sinus rhythm and cavotricuspid isthmus-dependent atrial flutter exhibited the lowest risk. Additionally, reduced kidney function was associated with a reduction in LAA flow velocities (p = 0.04). Of note, two LAA thrombi occurred in patients in sinus rhythm and six out of nine patients with an LAA thrombus were on vitamin-K antagonists. Conclusions: LAA thrombus is a rare occurrence before an elective catheter ablation. The underlying rhythm and kidney function may serve as markers of a higher likelihood of significantly reduced LAAEV and LAA thrombus.

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Section: Discussionmentioning

confidence: 79%

Incidence and Predictors of Left Atrial Appendage Thrombus before Catheter Ablation of Thrombogenic Arrhythmias

Wegner

Radke

Ellermann

et al. 2022

JPM

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“…Beyond underlying pathophysiological structural changes of the LA and different prediction models, variations in conduction such as channelopathies, shifts in electrolytes, modulation of the vagal tone or pulmonary vein ectopy due to lifestyle factors lead to the occurrence of AF (35)(36)(37)(38)(39). In the analysis of the EAHsy-AF cohort, no patient showed hyperthyroidism, alcohol abuse, channelopathies or performed regular extreme endurance sports.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic Parameters to Predict Atrial Fibrillation in Clinical Routine—The EAHsy-AF Risk Score

Sieweke

Hagemus

Biber

et al. 2022

Front. Cardiovasc. Med.

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BackgroundEchocardiographic parameters representing impaired left atrial (LA) function and remodeling are of high value to predict atrial fibrillation (AF). This study aimed to develop a prediction model for AF easily to apply in clinical routine containing echocardiographic parameters associated with LA remodeling and—function.Methods and ResultsThis monocentric, semi-blinded, controlled analysis included 235 patients to derive a prediction model. This prediction model was tested in a validation cohort encompassing 290 cardiovascular inpatients. The derivation and validation cohort included 54 (23%) and 66 (23%) patients with AF, respectively. Transthoracic echocardiography, comprising parameters indicating left atrial remodeling [septal/lateral total atrial conduction time (s/l PA-TDI)] and left atrial volume indexed to a' (LAVI/a') was performed in each patient. Based on multivariable regressions analysis, four variables were enclosed into the EAHsy (Echocardiography, Age, Hypertension)-AF risk score for AF prediction: Hypertension, Age, LAVI/a‘ and septal PA-TDI. In the validation cohort discrimination was strong (C-statistic 0.987, 95%CI 0.974–0.991) with an adequately performed calibration. The EAHsy-AF risk score was associated with a more precise prediction of AF in comparison to commonly used AF-scores (CHADS2-, ATLAS-, ARIC-, CHARGE-AF score).ConclusionThe EAHsy-AF-Score containing age, hypertension and echocardiographic parameters of atrial dysfunction and remodeling precisely predicts the incidence of AF in a general population of patients with cardiovascular disease. The EAHsy-AF risk score may enable more selective rhythm monitoring in specific patients at high risk for AF.

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“…Family history of structural cardiac diseases (eg, Hypertrophic Cardiomyopathy, Brugada Syndrome) or neurovascular disorders should also be evaluated especially in relatively younger patients. 8 , 9 …”

Section: History and Patient Characteristicsmentioning

confidence: 99%

How Should We Approach Syncope in the Emergency Department? Current Perspectives

Çanakçı¹,

Sevik²,

Acar³

2022

OAEM

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Syncope is a clinical picture that can affect all age groups and has an important place in admissions to the emergency department. There is an important diagnostic challenge in cases where there are different clinical presentations and patients cannot express the situation clearly. Although the emergency department facilities for the diagnosis of syncope are limited, the diagnosis of many patients can be differentiated from life-threatening conditions with a detailed history and physical examination. High-risk patients should be identified and directed for definitive treatment by emergency medicine physicians. This review contains information about the management of the syncope patient in the emergency department.

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Brugada syndrome and syncope: A systematic review

Cited by 26 publications

References 11 publications

Incidence and Predictors of Left Atrial Appendage Thrombus before Catheter Ablation of Thrombogenic Arrhythmias

Incidence and Predictors of Left Atrial Appendage Thrombus before Catheter Ablation of Thrombogenic Arrhythmias

Echocardiographic Parameters to Predict Atrial Fibrillation in Clinical Routine—The EAHsy-AF Risk Score

How Should We Approach Syncope in the Emergency Department? Current Perspectives

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