Syncope Without Prodromes in Patients With Normal Heart and Normal Electrocardiogram
Open accessAbstract
Objectives This study sought to investigate the clinical and laboratory findings of patients affected by sudden-onset syncope without prodromes who had a normal heart and normal electrocardiogram.Background The pathophysiology of syncope in these patients is uncertain.Methods We compared the clinical and laboratory findings of 15 patients with sudden-onset syncope without prodromes who had a normal heart and normal electrocardiogram (the study group) with those of 31 patients with established vasovagal syncope (VVS).Results The patients in the study group were older than those with VVS (age 61 ± 12 years vs. 46 ± 17 years) and had a history of fewer episodes of syncope (median of 2 [interquartile range [IQR]: 1 to 2.5] vs. 9 [IQR: 4 to 15] years) that were of more recent onset (median of 1 [IQR: 0 to 1] vs. 10.5 [IQR: 3.3 to 27] years). The study group had lower median baseline adenosine plasmatic levels than the VVS group (0.25 μmol/l [95% confidence interval: 0.10 to 1.51] vs. 0.85 μmol/l [95% confidence interval: 0.32 to 2.80]). On receiver-operating characteristic curve analysis, the adenosine plasmatic level of ≤0.36 best discriminated between groups, displaying 73% sensitivity and 93% specificity. Tilt table testing was more frequently positive in patients with VVS than in the study group (74% vs. 33%). A similarly high positivity rate of adenosine/adenosine triphosphate testing was found in both groups.Conclusions Common clinical features and a low adenosine plasmatic level define a distinct form of syncope, distinguish it from VVS, and suggest a causal role of the adenosine pathway.
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ATP testing was positive in most patients with syncope of unknown origin, especially syncope without prodrome and without structural heart disease, but not in controls.
“ATP testing was positive in most patients with syncope of unknown origin (especially syncope without prodrome and without structural heart disease 4 ) but not in controls”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [4]
The Discussion reports a 60% positive adenosine/ATP-test rate in patients with sudden syncope without prodromes and a normal heart. It does not support 'not in controls': it reports a 5% positive rate in people without syncope and says testing was also frequently positive in the study's vasovagal-syncope control group. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe adenosine/adenosine triphosphate (ATP) provocation test has been performed to demonstrate the utility of adenosine sensitivity and paroxysmal cardioinhibitory propensity for the selection of appropriate pacemaker candidates.
“In parallel, the adenosine/adenosine triphosphate (ATP) provocation test has been performed to demonstrate the utility of adenosine sensitivity and paroxysmal cardioinhibitory propensity for the selection of appropriate pacemaker candidates. 4,227,228”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [4]
The Methods (pp. 1075–80) describe adenosine/ATP provocation testing and define a positive result by prolonged atrioventricular block or asystole. But the Discussion says the test could not distinguish the study group from patients with vasovagal syncope; the paper does not demonstrate its utility for selecting pacemaker candidates. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn patients with low-adenosine syncope, tilt testing is usually negative.
“Unlike in VVS, tilt testing is usually negative. 4,226”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [4]
The entity of 'low-adenosine syncope' has been described in patients with otherwise unexplained syncope with sudden onset without prodrome, a normal heart, and normal ECG.
“Similarly, the entity of ' low-adenosine syncope ' has recently been described in patients who have an otherwise unexplained syncope with sudden onset without prodrome, a normal heart, and normal ECG. 4”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [4]
Cardiac pacing effectively prevents syncopal recurrences in this syndrome.
“Cardiac pacing effectively prevents syncopal recurrences.112,139,140”
From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [139]
The Methods and Results describe adenosine levels and diagnostic testing, not treatment or recurrence after pacing. The Discussion discusses a possible mechanism and an ongoing study, but does not establish that cardiac pacing prevents syncopal recurrences (searched: pacing, pacemaker, recurrence, and treatment). (LLM, conf=0.76)
Experimental — accuracy not yet measured
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Coșeriu, G., Șchiop-Țentea, P., Apetrei, C.-A., Mindreanu, I.-G., Sârb, A.-D., Moldovan, M. P., Lazar, R.-D., Avram, T., Chiorescu, R. M., Guşetu, G., et al. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13226852
- Authors
- Deharo, J.-C., Guieu, R., Mechulan, A., Peyrouse, E., Kipson, N., Ruf, J., Gerolami, V., Devoto, G., Marrè, V., & Brignole, M.
- Affiliations
- Hôpital de la Timone (FR)
- Presidio Ospedaliero (IT)
- Corresponding author
- Brignole, Michele
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-09
- Volume
- 62
- Issue
- 12
- Pages
- 1075-1080
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2146821111
- Cited by
- 53
- References
- 22
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 5 · 2021: 7 · 2020: 3 · 2019: 7 · 2018: 9 · 2017: 5 · 2016: 4 · 2015: 7 · 2014: 4
- FWCI
- 4.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American College of Cardiology Foundation
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- vasovagal syncope, adenosine triphosphate, adenosine pathway, tilt table test, differential diagnosis of syncope, normal electrocardiogram, normal heart
- MeSH terms
- Adenosine, Adolescent, Adult, Aged, Electrocardiography, Female, Humans, Male, Middle Aged, Syncope, Young Adult, Prodromal Symptoms
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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