Emerging concepts in diagnosis and treatment of syncope by pacing
File(s)EmergingConcepts01.16.18.docx (133.33 KB)
Accepted version
Author(s)
Sutton, R
Deharo, J-C
Brignole, M
Hamdan, MH
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
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/.
Source Database
pubmed
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/29452744
S1050-1738(18)30013-6
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Pacing
Syncope
Reflex syncope
Adenosine-related syncope
Tilt testing
Phase 4 depolarization
NEURALLY-MEDIATED SYNCOPE
UNCERTAIN ETIOLOGY ISSUE-3
PAROXYSMAL ATRIOVENTRICULAR-BLOCK
ACUTE MYOCARDIAL-INFARCTION
DOCUMENTED ASYSTOLE
VASOVAGAL SYNCOPE
STANDARDIZED ALGORITHM
UNEXPLAINED SYNCOPE
PACEMAKER THERAPY
RANDOMIZED-TRIAL
Adenosine-related syncope
Pacing
Phase 4 depolarization
Reflex syncope
Syncope
Tilt testing
Adenosine
Algorithms
Biomarkers
Cardiac Pacing, Artificial
Clinical Decision-Making
Electrocardiography
Heart
Humans
Patient Selection
Predictive Value of Tests
Reflex
Syncope
Tilt-Table Test
Treatment Outcome
Heart
Humans
Syncope
Adenosine
Electrocardiography
Tilt-Table Test
Reflex
Treatment Outcome
Cardiac Pacing, Artificial
Predictive Value of Tests
Algorithms
Patient Selection
Biomarkers
Clinical Decision-Making
Adenosine-related syncope
Pacing
Phase 4 depolarization
Reflex syncope
Syncope
Tilt testing
Cardiovascular System & Hematology
1102 Cardiorespiratory Medicine and Haematology
Publication Status
Published
Country
United States
Date Publish Online
2018-02-13