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Cited by 40Cardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic ControlVestibular and auditory disorders

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Transient modification of baroreceptor response during tilt-induced vasovagal syncope

Open access
Samniah, N·2004·Europace
DOI 10.1016/j.eupc.2003.09.004
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Abstract

AIMS: Normally, arterial baroreceptors attempt to minimize systemic hypotension by initiating reflex vasoconstriction and tachycardia. However, in the setting of vasovagal syncope (VVS), these usual compensatory mechanisms either fail to be triggered or the response is inadequate. We hypothesized that in VVS prone individuals, arterial baroreceptor response (BRR) is normal under most conditions, but that a transient functional BRR disturbance occurs during an evolving vasovagal faint and may in part account for failure of the usual compensatory response. METHODS AND RESULTS: This study assessed BRR in the baseline state and again in association with either VVS induced head-up tilt (HUT) or after a prolonged period of upright posture without VVS. To minimize impact on HUT outcome, BRR was estimated non-pharmacologically by measuring blood pressure and heart rate changes, induced when subjects were returned to the supine position after undergoing diagnostic 70 degrees HUT evaluation. Beat to beat heart rate and arterial blood pressure changes were recorded in 13 patients with syncope and another 16 individuals with negative HUT (control group). Baseline BRR was initially evaluated at the end of a 3 min symptom free HUT (HUT#1), and the measurement was repeated after a 45 min duration HUT in the control group or in conjunction with syncope in VVS prone individuals (HUT#2). Baseline BRR did not differ significantly in controls and VVS prone individuals (controls: 3.37+/-1.56, VVS prone: 6.0+/-2.02 ms/mmHg, p=0.27). Further, at the end of 45 min HUT#2, BRR was unaltered from baseline in control subjects (4.92+/-1.36 ms/mmHg, p=0.48), but was markedly reduced from baseline value in individuals who experienced a faint, -3.30+/-0.81 ms/mmHg (p<0.0003 vs baseline). CONCLUSION: Compared with individuals who do not manifest VVS during HUT, VVS prone individuals appear to demonstrate functional diminution of baroreceptor responsiveness. This altered response may undermine the normal expected compensatory response to evolving systemic hypotension. The basis for this transient disturbance in baroreceptor responsiveness is currently unknown.

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  • Reductions in baroreflex sensitivity have been demonstrated in presyncopal states by some studies, although the literature is not consistent, probably due to methodological differences.

    “Indeed, reductions in baroreflex sensitivity have been demonstrated in presyncopal states by some studies, although the literature is not consistent, probably also due to methodological differences (e.g., Iacoviello et al., 2008; Samniah et al., 2004).”

    From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Samniah et al., 2004

    The Discussion reports diminished baroreceptor responsiveness during evolving tilt-induced vasovagal syncope. But Study limitations distinguishes this study’s measure of baroreceptor responsiveness (BRR) from conventional baroreflex sensitivity (BRS). The Methods and Study limitations note methodological differences in measured values, but do not establish that those differences explain inconsistent findings across the presyncope literature. (LLM, conf=0.86)

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Research works printed but not linked: 18

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Metadata

Authors
Samniah, N.
Affiliations
University of Minnesota (US)
Corresponding author
Samniah, N
Venue
Europace
Publisher
Oxford University Press (OUP)
Published
2004-01
Volume
6
Issue
1
Pages
48-54
ISSN
1099-5129 (ISSN-L)
DOI
10.1016/j.eupc.2003.09.004
OpenAlex
W2163890741
Cited by
40
References
1
Citations by year
2026: 2 · 2024: 1 · 2023: 3 · 2022: 2 · 2020: 2 · 2019: 1 · 2018: 3 · 2017: 3 · 2016: 4 · 2015: 3 · 2014: 3 · 2013: 3 · 2012: 2
FWCI
0.65
Type
journal article
Language
en
Open access
Locations
  • EP Europace (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
Keywords
vasovagal syncope, baroreflex, head-up tilt, baroreflex sensitivity, systemic hypotension, heart rate, blood pressure
MeSH terms
Aged, Blood Pressure, Electrocardiography, Female, Heart Rate, Humans, Male, Middle Aged, Case-Control Studies, Baroreflex, Tilt-Table Test, Syncope, Vasovagal

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