Electrocardiographic Patterns in Patients with Neurally Mediated Syncope

Abstract

The baseline electrocardiogram (ECG) is less informative in neurally mediated syncope (NMS) than in arrhythmic syncope. However, some of the ECG patterns present in NMS can have diagnostic and prognostic value in such patients. Electrocardiographic documentation of a syncopal spell and thus identification of the ECG changes can be performed during tilt table test (TTT) or during prolonged ECG monitoring. This work reviews the specific ECG patterns in NMS, which are primarily related to the cardioinhibitory reflex. In addition, there are other ECG findings present in patients with NMS that are being analyzed, such as increased heart rate variability as well as specific QRS voltage patterns. In addition to the diagnostic and prognostic value, these ECG patterns in NMS may help improving the selection of patients for pacemaker implant.

Delayed Vasovagal Reaction with Reflex Syncope Following COVID-19 Vaccination

“…In particular, in syncope with delayed VVR, the cardioinhibitory type of VVR [cardioinhibitory response (CI)] seems more serious than the vasodepressor type of VVR [vasodepressor response (VD)], even though previous studies have shown that both types pose a sizable risk of inducing adverse outcomes ( 9 ). However, since CI manifests as cardiac arrest and advanced atrioventicular (AV) node blocks that might lead to sudden cardiac death, CI has been considered more serious than VD ( 9 ). Thus, it has been postulated that the delayed form of VVR syncope may cause CI.…”