Predicting Neurally Mediated Syncope Based on Pulse Arrival Time: Algorithm Development and Preliminary Results

Abstract

Predicting NMS is feasible by monitoring HR and the onset of the pulse wave at the periphery. This approach might improve NMS management.

Pulse Arrival Time as surrogate for systolic blood pressure changes during impending neurally mediated syncope

“…These findings confirm the predictive value of our risk score defined in [4] to detect an impending faint as well as our results on using HR-PAT plots with 1) a high risk of syncope, when a relative PAT increase is detected and 2) a low risk, when PAT is constant or decreases both independent of HR [15]. This consistent PAT response suggests a well-defined response of PEP during impending faint.…”

“…Warning devices to detect impending syncope due to regulation failures are not available yet, but might find applications to improve syncope training or as personal safe guard [4,5]. Manuscript Blood pressure (BP) could be a parameter to detect impending syncopes as demonstrated in a first feasibility study based on continuous blood pressure monitoring using the vascular unloading technique [6].…”

Hemodynamic Surrogate Measures Symplifying Neurally Mediated Syncope Management

“…Continuous SBP was measured with a Taskforce Monitor [7]. Details on signal processing can be found in [4,8]. Here, bradycardia is defined as a heart rate of less than 40 bpm and hypotension as systolic blood pressure of less than 80 mmHg.…”

“…During scheduled tilt table tests based on a standardized protocol [10] HR and PATs were extracted from simultaneously acquired electrocardiogram (ECG) and the finger photoplethysmogram (PPG) measured with a Philips MP50. PAT is defined as time span between the ECG-R-peak and pulse onset (PATfoot) or pulse maximum (PATtop) in a peripheral photo-plethysmography (PPG) signal [4]. Continuous SBP was measured with a Taskforce Monitor [7].…”

“…These reference values are determined 1 min after the patient was brought into up-right position at the beginning of a tilt table test [4]. Using these measures tilt positive patients can be easily separated from tilt negative as shown in Figure 2, where a plot of the normalized PATfoot and HR is presented for both patients groups (red dot: tilt positive, blue: tilt negative).…”