Mechanism of syncope without prodromes with normal heart and normal electrocardiogram
Abstract
Background "Unexplained syncope, no prodromes, and normal heart" has been described as a distinct clinical and biological entity.Objective The purpose of this study was to assess the mechanism of syncope.Methods In this prospective multicenter study, 58 patients presenting with unexplained syncope, no prodromes, and a normal heart received an implantable loop recorder (ILR) and were followed up until a diagnosis was established. Their outcomes were compared with those of 389 patients affected by reflex syncope with prodromes who received an ILR.Results During a mean observation period of 16 ± 13 months, a diagnostic event was documented by the ILR in 29 patients (50%); an asystolic pause of 11 ± 5 seconds (range 3.5-22 seconds) was present at the time of the diagnostic event in 19 patients (66%). Compared with patients affected by reflex syncope with prodromes, patients with unexplained syncope, no prodromes, and a normal heart more frequently had an asystolic syncope (66% vs 47%; P = .001), and this was more frequently due to idiopathic paroxysmal atrioventricular block (47% vs 21%; P = .04). Ten patients with asystolic pauses underwent cardiac pacing, and 8 patients underwent oral theophylline treatment. During the subsequent 17 ± 12 months of follow-up, syncope recurred in 1 patient on theophylline and presyncope occurred in 1 patient with pacemaker.Conclusion A long asystolic pause, frequently due to idiopathic paroxysmal atrioventricular block, played a role in the mechanism of syncope in two-thirds of patients who had electrocardiographic documentation of a diagnostic event. When a specific therapy was administered in patients with asystolic syncope, the short outcome was favorable.
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In a series of case reports, theophylline appeared effective in patients with recurrent sudden onset (pre)syncope who presented with low circulating adenosine levels.
“In a series of case reports, theophylline appeared effective in patients with recurrent sudden onset (pre)syncope who presented with the common biological characteristic of low circulating adenosine levels. 285,286”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [286]
In an intra-patient comparison, theophylline reduced prolonged asystolic pauses from a median of 1.11 per month during 13 months of no treatment to 0 per month during 20 months of theophylline treatment, with symptoms disappearing.
“An intra-patient comparison between a period with and a period without theophylline therapy, with the support of prolonged ECG monitoring, showed that symptoms disappeared and the number of prolonged asystolic pauses was impressively reduced from a median of 1.11 per month during 13 months of no treatment to 0 per month during 20 months of theophylline treatment.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [286]
No syncope recurrence was observed after permanent cardiac pacing in 10 patients who had ECG documentation of asystolic pause due to sinus arrest or AV block.
“No syncope recurrence was observed after permanent cardiac pacing in 10 patients who had ECG documentation of asystolic pause due to sinus arrest or AV block. 286”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [286]
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- Authors
- Brignole, M., Guieu, R., Tomaino, M., Iori, M., Ungar, A., Bertolone, C., Unterhuber, M., Bottoni, N., Tesi, F., & Claude Deharo, J.
- Affiliations
- Presidio Ospedaliero (IT)
- Ospedale di Bolzano (IT)
- Santa Maria Nuova Hospital (IT)
- Azienda Ospedaliero-Universitaria Careggi (IT)
- Corresponding author
- Brignole, Michele
- Venue
- Heart Rhythm
- Publisher
- Elsevier BV
- Published
- 2017-02
- Volume
- 14
- Issue
- 2
- Pages
- 234-239
- ISSN
- 1547-5271 (ISSN-L)
- OpenAlex
- W2520129420
- Cited by
- 59
- References
- 19
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 5 · 2021: 12 · 2020: 7 · 2019: 14 · 2018: 10 · 2017: 3
- FWCI
- 9.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart Rhythm (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Florence Research (University of Florence) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- reflex syncope, implantable loop recorder, cardiac pacing, theophylline, syncope mechanism, syncope recurrence
- MeSH terms
- Aged, Cardiac Pacing, Artificial, Female, Heart Arrest, Humans, Male, Middle Aged, Prospective Studies, Recurrence, Syncope, Theophylline, Vasodilator Agents, Electrocardiography, Ambulatory, Treatment Outcome, Atrioventricular Block
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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