Syncope Without Prodromes in Patients With Normal Heart and Normal Electrocardiogram

Deharo, Jean‐Claude; Guieu, Régis; Mechulan, Alexis; Peyrouse, Eric; Kipson, Nathalie; Ruf, Jean; Gérolami, V.; Devoto, Gianluigi; Marrè, Vanna; Brignole, Michele

doi:10.1016/j.jacc.2013.05.060

Cited by 54 publications

(60 citation statements)

References 19 publications

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“…Among patients with a positive tilt-table test, a benefit of pacing for treatment of recurrent syncope was evident as compared with medical or no therapy in open-label trials, 52,404,406,[410][411][412] but this result must be interpreted with caution because of the possibility of outcome ascertainment bias. In 2 RCTs, there was no statistically significant benefit seen with active pacing.…”

Section: -408410mentioning

confidence: 99%

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

Sheldon²,

et al. 2017

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Section: -408410mentioning

confidence: 99%

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

Sheldon²,

et al. 2017

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“…High APC was previously repeorted in VVS [3,16]. This high APC is responsible for the drop in blood pressure and loss of consciousness.…”

Section: Discussionmentioning

confidence: 99%

“…This high APC is responsible for the drop in blood pressure and loss of consciousness. Conversely, low adenosine is associated with sudden syncope [2,3]. This last kind of syncope has a more pejorative prognosis because lacking prodromes and because the cause of loss of consciousness is often atrio-ventricular block [3].…”

Section: Discussionmentioning

confidence: 99%

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Rapid Measurement of Adenosine Concentration in Human Blood Using Fixed Potential Amperometry: Comparison with Mass Spectrometry and High- Performance Liquid Chromatography

Marlinge¹,

Vairo²,

Marolda³

et al. 2017

J Anal Bioanal Tech

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Background: Adenosine is a nucleoside that impacts the cardiovascular system during cardiovascular or inflammatory diseases. The rapid determination of adenosine in blood may be useful in emergency medicine especially in syncope diagnose or septic shock. We compare its measurement in blood using fixed potential amperometry (FPA), with usual methods: mass spectrometry (LC-MS/MS) or high performance liquid chromatography (HPLC). Methods:Twenty healthy subjects (14 men and 6 women) and ten patients suffering from vasovagal syncope (VVS, 6 women and 4 men) were included. Blood samples were collected by vein puncture for plasma adenosine assay and in the same time using finger puncture for direct FAP measurement and on blotting paper for LC-MS/MS. Results:Mean plasma adenosine concentration was 26% higher using HPLC compared with LC-MSMS; p<0.01. In whole blood, adenosine concentration was 35% higher using FPA compared with LC-MS/MS. We found a good correlation between adenosine values measured by FAP and LC-MS/MS in whole blood and between LC-MS/MS and HPLC in plasma. Mean adenosine concentration was higher in patients whatever the method used. Conclusion:Adenosine measurement to the patient's bed, using FPA may be useful in some cases where high adenosine is associated with pejorative outcome.

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“…In those patients in whom a spontaneous ECG could be recorded at the time of a spontaneous syncope, the ECG showed paroxysmal AV block with one or multiple consecutive pauses, without P-P cycle lengthening or PR interval prolongation. In these patients, cardiac pacing was very effective in preventing syncopal recurrences [22,23].…”

Section: Evidence From the Trials In Patients With Adenosine-sensitivmentioning

confidence: 99%

Pacing for neurally-mediated syncope: How to decide?

Brignole

2014

Cardiol J

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Effectiveness of pacing in tilt-induced vasovagal syncope patients has been studied in 5 multi-center randomized clinical trials [1-5]; 3 non-blinded trials gave positive results and 2 blinded trials gave negative results. Adding together the results of the 5 trials, 318 patients were evaluated; syncope recurred in 21% of the paced patients and in 44% of unpaced patients (p < 0.001). A recent meta-analysis of all studies suggested a non-significant 17% reduction in syncope from the double-blinded studies, and an 84% reduction in the studies where the control group did not receive a pacemaker (PM) [6].All these studies have their limitations. A comparison of these studies causes slight difficulties because of important differences in study design, largely focused on patient selection. Overall, in typical vasovagal population pacing seems to have marginal efficacy. These findings suggest caution in implanting a PM based on the tilt response.Typically, the vasovagal reflex is both hypotensive and cardioinhibitory. The rationale for efficacy of cardiac pacing is that the cardio-inhibitory reflex is dominant in some patients, since there is no role for pacing in preventing vasodilatation and hypotension. While there is a growing skepticism over diagnostic accuracy of tilt testing (TT) for syncope diagnosis, emerging evidence support the use of tilt table testing in assessing susceptibility to reflex hypotension [7]. In this study it is discussed how to decide who can benefit from pacing when vasovagal syncope is present.

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Syncope Without Prodromes in Patients With Normal Heart and Normal Electrocardiogram

Abstract: Common clinical features and a low adenosine plasmatic level define a distinct form of syncope, distinguish it from VVS, and suggest a causal role of the adenosine pathway.

Cited by 54 publications

References 19 publications

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

Rapid Measurement of Adenosine Concentration in Human Blood Using Fixed Potential Amperometry: Comparison with Mass Spectrometry and High- Performance Liquid Chromatography

Pacing for neurally-mediated syncope: How to decide?

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