Neurally mediated cardiac syncope: autonomic modulation after normal saline infusion
Open accessAbstract
Objectives This study assessed the heart variability response to orthostatic stress during tilt table testing before and after normal saline administration.Background The efficacy of sodium chloride and mineralocortoid in the treatment of neurally mediated cardiac syncope is attributed to intravascular volume expansion; however, their modulation of autonomic nervous system activity has not been evaluated.Methods Heart rate variability analysis was performed on 12 adolescents with a history of syncope or presyncope (mean age 15.2+/-0.7 years) during tilt table testing. Subjects were upright 80 degrees for 30 min or until syncope. After normal saline administration, the patient was returned upright for 30 min. Heart rate variability analysis data were analyzed by an autoregression model (Burg method).Results All subjects reproducibly developed syncope during control tilt table testing; median time to syncope was 9.4+/-2.1 min. After normal saline infusion, none of the subjects developed syncope after 30 min upright. In the control tilt, there was an initial increase followed by a progressive decrease in low frequency power until syncope. Repeat tilt after normal saline administration demonstrates that low frequency power increased but the magnitude of initial change was blunted when compared with control. In addition, low frequency power increased during normal saline tilt sequence compared with the control tilt, during which it decreased.Conclusions Normal saline blunted low frequency power stimulation and prevented paradoxical low frequency power (sympathetic) withdrawal. Increasing intravascular volume with normal saline alters autonomic responses that may trigger neurally mediated syncope reflexes.
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Saline infusion has proved effective in acute tilt test studies.
“The mechanism of action can be compared with that of saline infusion, which has also proved effective in acute tilt test studies. 274”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [274]
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- Authors
- Burklow, T. R., Moak, J. P., Bailey, J. J., & Makhlouf, F. T.
- Affiliations
- Children's National (US)
- National Institutes of Health (US)
- United States Department of Defense (US)
- Corresponding author
- Moak, Jeffrey P
- ORCID
- Moak, Jeffrey P
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 1999-06
- Volume
- 33
- Issue
- 7
- Pages
- 2059-2066
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2114072680
- Cited by
- 39
- References
- 48
- Citations by year
- 2025: 2 · 2023: 1 · 2022: 1 · 2021: 3 · 2020: 2 · 2019: 1 · 2018: 5 · 2017: 1 · 2016: 2 · 2015: 2 · 2014: 1 · 2013: 1 · 2012: 2
- FWCI
- 0.70
- 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 › 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
- neurally mediated syncope, normal saline infusion, autonomic nervous system, heart rate variability, orthostatic stress, tilt table test, intravascular volume expansion, sympathetic withdrawal, adolescents, low-frequency power
- MeSH terms
- Adolescent, Autonomic Nervous System, Blood Pressure, Blood Volume, Child, Circadian Rhythm, Female, Heart Rate, Humans, Infusions, Intravenous, Male, Sodium Chloride, Syncope, Reproducibility of Results, Electrocardiography, Ambulatory, Tilt-Table Test
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