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An Implantable Loop Recorder Study of Highly Symptomatic Vasovagal Patients
Open accessAbstract
Objectives The aim of this study was to analyze the heart rhythm during spontaneous vasovagal syncope (VVS) in highly symptomatic patients with implantable loop recorders (ILR) and to correlate this rhythm with the heart rhythm observed during head-up tilt test (HUT).Background Heart rhythm obtained during provocative condition is often used to guide therapy in VVS. To date there is no conclusive evidence that the heart rhythm observed during a positive HUT can predict heart rhythm during VVS or that the heart rhythm observed during a spontaneous syncope will be identical to the recurrent syncope.Methods Twenty-five consecutive VVS patients (age 60.2 +/- 17.1 years; 14 women,) presenting with frequent syncopes (6.9 +/- 4.6 episodes/year) and a positive HUT (cardioinhibitory in 8 patients) were implanted with an ILR. Seven of them also had a positive adenosine triphosphate (ATP) test.Results Follow-up was 17.0 +/- 3.6 months. Thirty VVS were observed in 12 patients. Nine episodes showed bradycardia of <40 beats/min or asystole; progressive sinus bradycardia preceding sinus arrest was the most frequent electrocardiographic finding. Twenty-one syncopes occurred without severe bradycardia. The heart rhythm observed during the first syncope was identical to the recurrence. No correlation was found between slow heart rate at the ILR interrogation and a cardioinhibitory HUT response (p = 1.0) or a positive ATP test (p = 1.0).Conclusions In highly symptomatic patients with VVS, the heart rhythm observed during spontaneous syncope does not correlate with the HUT. The heart rhythm during the first spontaneous syncope is identical to the recurrent syncope.
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“While a positive cardioinhibitory response to tilt testing predicts, with a high probability, an asystolic spontaneous syncope, the presence of a positive vasodepressor, mixed response, or even a negative response, does not exclude the presence of asystole during spontaneous syncope. 122,123”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [122]
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“A positive cardioinhibitory response to tilt testing predicts, with high probability, asystolic spontaneous syncope; this finding is relevant for therapeutic implications when cardiac pacing is considered (see section 5.2.6).”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [122]
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“While a positive cardioinhibitory response to tilt testing predicts, with a high probability, an asystolic spontaneous syncope, the presence of a positive vasodepressor, mixed response, or even a negative response, does not exclude the presence of asystole during spontaneous syncope. 122,123”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [122]
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“Conversely, the presence of a positive vasodepressor, a mixed response, or even a negative response does not exclude the presence of asystole during spontaneous syncope. 122,123”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [122]
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“previous studies showed no correlation between AV block induced by ATP and ECG findings (documented by ILR) during spontaneous syncope. 122,123,227”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [122]
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Metadata
- Authors
- Deharo, J.-C., Jego, C., Lanteaume, A., & Djiane, P.
- Affiliations
- Hôpital de la Timone (FR)
- Corresponding author
- Deharo, Jean-Claude
- ORCID
- Deharo, Jean-Claude
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2006-02
- Volume
- 47
- Issue
- 3
- Pages
- 587-593
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W24220055
- Cited by
- 110
- References
- 25
- Citations by year
- 2025: 2 · 2024: 4 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 1 · 2019: 1 · 2018: 4 · 2017: 3 · 2016: 3 · 2015: 6 · 2014: 9 · 2013: 12 · 2012: 8
- FWCI
- 12.43
- 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 › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- vasovagal syncope, implantable loop recorder, head-up tilt, cardioinhibitory syncope, bradycardia, sinus arrest, asystole, cardiac rhythm, syncope recurrence
- MeSH terms
- Adenosine Triphosphate, Aged, Aged, 80 and over, Female, Heart Rate, Humans, Male, Middle Aged, Recurrence, Electrocardiography, Ambulatory, Tilt-Table Test, Syncope, Vasovagal
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