Does any therapy really work for neurocardiogenic syncope?

Hawkins, Nathaniel M.; Krahn, Andrew D.

doi:10.5603/cj.2014.0094

Cited by 5 publications

(3 citation statements)

References 46 publications

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“…Dysautonomia is an umbrella term for conditions arising from dysfunction of the autonomic nervous system. These conditions include orthostatic hypotension, 12 neurocardiogenic syncope, 13 POTS, multiple system atrophy 14 and pure autonomic failure. 15 POTS is the most common type of dysautonomia.…”

Section: Introductionmentioning

confidence: 99%

Postural Orthostatic Tachycardia Syndrome: Diagnosis and Management Guide for Nurses

Seeley,

Lau,

Gallagher

2023

NRR

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Postural Orthostatic Tachycardia Syndrome (POTS) is a heterogeneous condition where sufferers often present with a variety of orthostatic and non-orthostatic symptomatology. The condition can result in significant functional limitations and reduced quality of life. Diagnosis is based upon patient history in combination with a simple test such as an Active Stand Test. Treatment is both pharmacologically and non-pharmacologically based, with most interventions demonstrating only modest efficacy. There is an urgent need for further research to enhance understanding of aetiology, diagnosis and treatment of this condition. Nurses are well placed to care for patients presenting with symptoms consistent with POTS, to undertake or recommend testing to facilitate diagnosis and to provide education and support as part of a multidisciplinary team to improve patient outcomes.

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Section: Introductionmentioning

confidence: 99%

Postural Orthostatic Tachycardia Syndrome: Diagnosis and Management Guide for Nurses

Seeley,

Lau,

Gallagher

2023

NRR

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“…As the exact mechanism underlying and triggering this clinical condition continues to be subject of studies and discussion, at the moment no therapy (i.e. physical maneuvers, tilt training, pharmacological therapy, cardiac pacing) has proven to completely prevent reflex syncope recurrence during long-term follow-up [ 1 , 5 ]. Among all the treatments, endocardial radiofrequency (RF) ablation of the ganglionated plexi (GPs) and parasympathetic network located close to the sinus node (SN) and atrio-ventricular node (AVN) has shown excellent long-term results in well-selected patients in some observational studies [ 6 ] and case reports [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

A novel strategy to treat vaso-vagal syncope: Cardiac neuromodulation by cryoballoon pulmonary vein isolation

Maj

Osório

Borio

et al. 2020

Indian Pacing and Electrophysiology Journal

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Background Clinical management of vaso-vagal syncope (VVS) remains challenging since no therapy has proven to completely prevent VVS recurrence. Objective The purpose of this study was to analyze the mid-term outcome of cryoballoon (CB) cardioneuroablation achieved by pulmonary vein isolation (PVI) in patients with VVS. Methods Patients who underwent CB cardioneuroablation in our centers between January 2014 to June 2018 were included. All patients had a history of VVS or pre-syncope despite therapeutic attempts with medical and/or pacing treatments. Patients were excluded in case of structural heart diseases, cerebrovascular diseases or suspected drug-related syncope. Both heart rate (HR) and atrio-ventricular (AV) interval were analyzed on the 12-lead electrocardiogram (ECG) the day before the procedure, the day after, and in the follow-up. Results In total, 26 patients (76.9% males, 37.5 ± 9.0 years old) were included. All patients underwent a successful procedure with the 28 mm second-generation Arctic Front Advance CB. No major complication occurred. At a mean follow-up of 20.1 ± 11.6 months the freedom from VVS or reflex pre-syncope was 83,7%, with 22 patients free from any clinical recurrence. Basal HR significantly increased the day after the procedure (57.2 bpm vs 78.3 bpm, p < 0.001), while at the final follow-up it stabilized at a value halfway between the 2 previous ones (69.8 bpm, p = 0.0086). The AV interval didn’t modify significantly after the procedure. Conclusion Endocardial autonomic denervation achieved by CB PVI appears to be an effective and safe treatment option for patients with refractory VVS and reflex pre-syncope.

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“…Given the lack of evidence supporting the effectiveness of traditional pharmacologic and device-based therapy for symptom reduction and improved quality of life in patients with NCS, it is reasonable to consider lifestyle modification-based therapies. Lifestyle recommendations can prove effective interventions in that they require adherence, which in itself can promote a placebo and expectancy response in addition to a salutary effect of the training itself [9]. As an ancient form of exercise including breathing exercises, meditation, and isotonic exercise in a variety of postures, yoga may offer an innovative, low-risk, costeffective lifestyle intervention with no significant side effects.…”

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confidence: 99%

When all else fails: take a deep breath, meditate, and assume padmasana

Kong

Winkle

2015

J Interv Card Electrophysiol

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Although common, neurocardiogenic syncope (NCS) encompasses a diversity of clinical presentations, disease states, and underlying pathophysiologic mechanisms. As such, treatment of NCS can prove quite challenging. Numerous treatment options exist for management of NCS including high salt and fluid intake, pharmacologic therapy, tilt training, isometric counterpressure maneuvers, and even implantation of cardiac pacemakers; however, NCS often proves refractory to these measures, for most of which no long-term, controlled clinical evidence of efficacy exists.A 2011 Cochrane Database meta-analysis examined the effects of pharmacologic and pacemaker therapy on patients with vasovagal or carotid sinus syncope [1]. This metaanalysis included 46 randomized controlled or randomized cross-over trials of drug therapy including beta-blockers, fludrocortisone, alpha-adrenergic agonists, selective serotonin reuptake inhibitors (SSRIs), salt tablets, anticholinergic agents, ACE inhibitors, disopyramide, and dual-chamber pacemaker implantation. The median sample size of these studies was only 42 patients, and the conclusion of the analysis was that insufficient evidence exists to support the use of pharmacologic therapy or pacemaker implants for NCS. Similarly, a more recent and comprehensive meta-analysis comprising both randomized and non-randomized studies further highlights the relative paucity of evidence for the commonly used therapies for vasovagal syncope [2]. When limiting the analysis to randomized studies, only midodrine (4 studies with n=400, odds ratio (OR) 0.19, confidence interval (CI) 0.06-0.62, p<0.05) and SSRIs (2 studies with n=131, OR 0.28, CI 0.01-0.74, p<0.05) appeared to be effective in preventing recurrent syncope. Meanwhile, beta-blockers, tilt training, and pacemaker implantation failed to show benefit in reducing syncope.Regarding device therapy for NCS, the devil remains in the details. A 2007 meta-analysis of nine randomized trials comparing pacemaker therapy with medical therapy, usual care, placebo, or different pacing algorithms revealed that permanent pacing decreased the risk of syncopal recurrence in unblinded studies (OR 0.09, CI 0.04-0.22) and studies comparing different pacemaker algorithms (OR 0.04, CI 0.0-0.23); however, in the two available double-blinded trials, there was no reduction in syncope recurrence (OR 0.83, CI 0.41-1.70) [3]. This study underscored the role of response expectancy, i.e., the awareness that a pacemaker was implanted and functioning reduced the risk of recurrent syncope (OR 0.16, CI 0.06-0.40, p=0.0001). Placebo effects have been observed in both invasive and non-invasive studies and subject response expectancy (patient expects improvement), and/or observer response expectancy (physician expects patient to improve) likely plays an important role in that NCS patients have demonstrated symptomatic improvement even without placebo [4]. This effect was particularly striking in the ISSUE 1 study, which was a prospective observational study in which 111 patients with t...

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Does any therapy really work for neurocardiogenic syncope?

Abstract: Effectiveness of a treatment for neurocardiogenic syncope can be defined in terms of (Cardiol J 2014; 21, 6: 616-624)

Cited by 5 publications

References 46 publications

Postural Orthostatic Tachycardia Syndrome: Diagnosis and Management Guide for Nurses

Postural Orthostatic Tachycardia Syndrome: Diagnosis and Management Guide for Nurses

A novel strategy to treat vaso-vagal syncope: Cardiac neuromodulation by cryoballoon pulmonary vein isolation

When all else fails: take a deep breath, meditate, and assume padmasana

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