The DOI matches its Crossref record; 26 of the 26 references it cites were found in a registry or an index.
Role of autonomic reflexes in syncope associated with paroxysmal atrial fibrillation
Open accessAbstract
Objectives The purpose of this study was to evaluate the role of autonomic reflexes in the genesis of syncope associated with the onset of paroxysmal atrial fibrillation.Background Syncope associated with paroxysmal atrial fibrillation has been interpreted as an ominous finding predictive of rapid ventricular rates. However, various mechanisms may be involved when heart rate is not particularly high.Methods Forty patients (age 60 +/- 14 years, 20 men, 20 women) with syncope and atrial fibrillation were compared with atrial fibrillation without syncope. Carotid sinus massage and head-up tilt testing (at 60 degrees for 60 min at baseline and during isoproterenol infusion) were performed during sinus rhythm. A positive response was defined as the induction of syncope. Atrial fibrillation was also induced on a tilt table at 60 degrees by means of short bursts of atrial pacing.Results Results of carotid sinus massage were positive in 15 (37%) of 40 patients but in no control subjects (p = 0.002). Head-up tilt test findings were positive in 25 (66%) of 38 patients and in 2 (12%) of 16 control subjects (p = 0.0004). The induction of atrial fibrillation in the upright position elicited syncope in 16 (42%) of 38 patients but in none of 16 control subjects (p = 0.001). At the beginning of atrial fibrillation, systolic blood pressure was lower in patients than in control subjects (88 +/- 32 vs. 127 +/- 32 mm Hg), whereas mean heart rate was similar (142 +/- 35 vs. 134 +/- 25 beats/min). The correlation between heart rate and systolic blood pressure was weak (r = 0.35), and in five patients syncope occurred at a heart rate < or = 130 beats/min. At the time of syncope, heart rate decreased (-12 +/- 21 beats/min) in patients with induced syncope, whereas it remained unchanged in patients without induced syncope (+1 +/- 17 beats/min, p = 0.04) or slightly increased in control subjects (+9 +/- 21 beats/min, p = 0.009).Conclusions Patients with syncope associated with paroxysmal atrial fibrillation are predisposed to an abnormal neural response during both sinus rhythm and arrhythmia. In some patients the onset of atrial fibrillation triggers vasovagal syncope.
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“and in 45-47% with true cardiac arrhythmic syncope. 130,131”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [130]
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“For example, in arrhythmic syncope caused by paroxysmal atrial tachyarrhythmias, the mechanism is a combination of onset of the arrhythmia itself and hypotensive susceptibility, corroborated by positive tilt testing. 130,131”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [130]
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Citations
Cites
Beaufils, F., & Boué, A. (1979) · The Lancet · doi:10.1016/s0140-6736(79)92830-7 · Cited by 2,428
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Cardiovascular autonomic reflex tests:normal responses and age‐related reference values
Piha, S. J. (1991) · Clinical Physiology · doi:10.1111/j.1475-097x.1991.tb00459.x · Cited by 144
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Self-citation
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Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), societies, E. B. T. F., European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp298 · Cited by 2,040
Self-citation2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya, A., de Lange, F. J., Deharo, J.-C., Elliott, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martín, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy037 · Cited by 1,951
Self-citationGuidelines on management (diagnosis and treatment) of syncope
Brignole, M. (2001) · European Heart Journal · doi:10.1053/euhj.2001.2739 · Cited by 951
Self-citationGuidelines on Management (diagnosis and treatment) of syncope ? update 2004
Brignole, M., Alboni, P., Benditt, D. G., Bergfeldt, L., Blanc, J., Thomsen, P. E. B., van Dijk, J. G., Fitzpatrick, A. P., Hohnloser, S. H., Janousek, J., et al. (2004) · EP Europace · doi:10.1016/j.eupc.2004.08.008 · Cited by 650
Self-citation2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.03.004 · Cited by 478
Metadata
- Authors
- Brignole, M., Gianfranchi, L., Menozzi, C., Raviele, A., Oddone, D., Lolli, G., & Bottoni, N.
- Affiliations
- Santa Maria Nuova Hospital (IT)
- Corresponding author
- Brignole, Michele
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 1993-10
- Volume
- 22
- Issue
- 4
- Pages
- 1123-1129
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W1989742523
- Cited by
- 114
- References
- 26
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2022: 3 · 2020: 5 · 2019: 5 · 2018: 10 · 2017: 6 · 2016: 4 · 2015: 5 · 2014: 5 · 2013: 5 · 2012: 4
- FWCI
- 2.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- syncope, paroxysmal atrial fibrillation, autonomic reflexes, carotid sinus massage, head-up tilt, isoproterenol, atrial fibrillation induction, orthostatic hypotension, heart rate, systolic blood pressure, autonomic dysfunction, syncope pathophysiology
- MeSH terms
- Aged, Atrial Fibrillation, Autonomic Nervous System, Blood Pressure, Cardiac Pacing, Artificial, Carotid Sinus, Echocardiography, Electrophysiology, Female, Heart Rate, Humans, Infusions, Intravenous, Isoproterenol, Male, Massage, Middle Aged, Predictive Value of Tests, Reflex, Syncope, Systole, Vagus Nerve, Causality, Case-Control Studies, Tachycardia, Ventricular
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