Emerging concepts in diagnosis and treatment of syncope by pacing
File(s)
Accepted version
Author(s)
Sutton, Richard
Deharo, Jean-Claude
Brignole, Michele
Hamdan, Mohamed H
Type
Journal Article
Abstract
Neuroendocrine syncope is a newly proposed term to embody both syncope of reflex and adenosine-related etiology. Recent publications on tilt testing have revealed the presence of a hypotensive tendency in some patients, even in the face of severe cardioinhibition. This new understanding may allow better selection of older reflex syncope patients, documented by ECG loop recorder, for successful pacing where tilt testing is ideally negative for a good result in terms of few syncope recurrences and prompts a less aggressive management policy when hypotensive medication is required. Furthermore, plasma adenosine levels not only define a new group of patients who have low adenosine and will respond well to cardiac pacing but also, by assessing adenosine receptor affinity, offer a possible explanation for vasodepression accompanying severe cardioinhibition. The question of the timing of loss of consciousness in reflex syncope needs to be addressed because, if consciousness is lost before asystole, pacing is likely to be ineffective.
Date Issued
2018-08-01
Date Acceptance
2018-01-30
Citation
Trends in Cardiovascular Medicine, 2018, 28 (6), pp.421-426
ISSN
1050-1738
Publisher
Elsevier
Start Page
421
End Page
426
Journal / Book Title
Trends in Cardiovascular Medicine
Volume
28
Issue
6
Copyright Statement
© 2018 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/29452744
PII: S1050-1738(18)30013-6
Subjects
Adenosine-related syncope
Pacing
Phase 4 depolarization
Reflex syncope
Syncope
Tilt testing
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2018-02-13