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Cited by 171Cardiovascular Syncope and Autonomic DisordersCardiac Arrhythmias and TreatmentsHeart Rate Variability and Autonomic Control

Syncope associated with supraventricular tachycardia. An expression of tachycardia rate or vasomotor response?

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Leitch, J W, Klein, G J, Yee, R, Leather, R A, Kim, Y H·1992·Circulation
DOI 10.1161/01.cir.85.3.1064
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Abstract

BACKGROUND: Syncope in patients with supraventricular tachycardia has been suggested to be an ominous finding, predictive of rapid rates during tachycardia. METHODS AND RESULTS: To explore the mechanism of syncope during supraventricular tachycardia, tachycardia was induced in the supine position and after passive head-up tilting to 60 degrees in 13 patients with atrioventricular (AV) node reentry, eight patients with AV reentry, and one patient with atrial tachycardia. Tilt testing was also performed in sinus rhythm for 30 minutes (the last 15 minutes with isoproterenol infusion). Mean +/- SEM age was 38 +/- 3 years, and 11 patients had a history of syncope (median number of syncopal episodes, three; range, one to 30). The cycle length of tachycardia when upright was shorter than when supine (297 +/- 9 compared with 357 +/- 10 msec, p less than 0.001), and mean blood pressure fell to a greater extent after the onset of tachycardia (fall in mean blood pressure, 53 +/- 6 compared with 24 +/- 3 mm Hg, p less than 0.001). Mean blood pressure correlated significantly with tachycardia cycle length when supine (r = 0.58, p = 0.005) but not when tilted upright (r = 0.18, p = 0.45). Syncope occurred in seven patients during upright tachycardia. These seven patients had a greater fall in mean blood pressure with upright tachycardia than the 15 patients without syncope (fall in mean blood pressure, 70 +/- 4 compared with 45 +/- 5 mm Hg, p = 0.01), but there was no difference in the tachycardia cycle length (311 +/- 10 compared with 290 +/- 11 msec, p = 0.29). Six of the seven patients with tachycardia-induced syncope also had syncope with tilt testing in sinus rhythm compared with four of the 15 patients without tachycardia-induced syncope (p = 0.02). CONCLUSIONS: These data support the view that syncope during supraventricular tachycardia is related to vasomotor factors and does not predict a more rapid tachycardia rate.

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  • Tilt testing was positive in 45-47% of patients with true cardiac arrhythmic syncope.

    “and in 45-47% with true cardiac arrhythmic syncope. 130,131”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [131]

    The Results report tilt-induced syncope in 45% of the study’s patients with supraventricular tachycardia. That percentage was not specifically for patients with confirmed arrhythmic syncope: six of seven who fainted during induced tachycardia also fainted during passive tilt testing, while five of the ten with a positive tilt test had never experienced clinical syncope. Page numbers are unavailable in our copy. (LLM, conf=0.88)

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  • In arrhythmic syncope caused by paroxysmal atrial tachyarrhythmias, the mechanism is a combination of onset of the arrhythmia itself and hypotensive susceptibility, corroborated by positive tilt testing.

    “For example, in arrhythmic syncope caused by paroxysmal atrial tachyarrhythmias, the mechanism is a combination of onset of the arrhythmia itself and hypotensive susceptibility, corroborated by positive tilt testing. 130,131”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [131]

    The Results and Discussion passages report that syncope during induced upright supraventricular tachycardia was associated with vasodepressor susceptibility: six of seven patients who fainted during tachycardia also fainted on passive tilt testing. But the study predominantly examined induced AV reentrant tachycardias, not paroxysmal atrial tachyarrhythmias generally, and cautions that the mechanism of spontaneous clinical syncope could not be determined. Page numbers are not provided in our copy. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Syncope may also occur at the onset of supraventricular tachycardia in patients with a normal heart, as the result of the triggering of a vasovagal reaction.

    “However, syncope may also occur at the onset of supraventricular tachycardia in patients with a normal heart, as the result of the triggering of a vasovagal reaction.62”

    From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [62]

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Cites

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Research works printed but not linked: 7

  1. Klein GJ, Prystowsky EN, Pritchett ELC, Davis D, Gallagher JJ: Atypical patterns of retrograde conduction over accessory atrio- ventricular pathways in the Wolff-Parkinson-White syndrome. Cir- culation 1979;60:1477-1488
  2. Kenny RA, Ingram A, Bayliss J, Sutton R: Head-up tilt: A useful test for investigating unexplained syncope. Lancet 1986;1:352-1355
  3. Goldreyer BN, Kastor JA, Kershbaum KL: The hemodynamic effects of induced supraventricular tachycardia in man. Circulation 1976;54:783-789
  4. McMichael J, Sharpey-Schafer EP: Cardiac output in man by a direct Fick method. Br Heart J 1944;6:33-40
  5. Robinson BF, Epstein SE, Beiser GD, Braunwald E: Control of heart rate by the autonomic nervous system: Studies in man on the interrelation between baroreceptor mechanisms and exercise. Circ Res 1966;19:400-411
  6. Lewis T, Drury AN, Bulgar HA: Observations upon atrial flutter and fibrillation: VII. The effects of vagal stimulation. Heart 1921; 8:141-169
  7. Volpe M, Lembo G, Condorelli G, et al: Converting enzyme inhibition prevents the effects of atrial natriuretic factor on barorelex responses in humans. Circulation 1990;82:1214-1221

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Authors
Leitch, J. W., Klein, G. J., Yee, R., Leather, R. A., & Kim, Y. H.
Affiliations
Western University (CA)
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1992-03
Volume
85
Issue
3
Pages
1064-1071
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/01.cir.85.3.1064
OpenAlex
W1990684611
Cited by
171
References
28
Citations by year
2026: 1 · 2025: 2 · 2024: 4 · 2023: 3 · 2022: 3 · 2021: 3 · 2020: 3 · 2019: 3 · 2018: 7 · 2017: 3 · 2016: 4 · 2015: 10 · 2014: 4 · 2013: 8 · 2012: 3
FWCI
6.36
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords
supraventricular tachycardia, atrioventricular nodal reentrant tachycardia, atrial tachycardia, head-up tilt, tachycardia cycle length, vasomotor response
MeSH terms
Adult, Blood Pressure, Cardiac Pacing, Artificial, Heart Rate, Humans, Isoproterenol, Posture, Syncope, Tachycardia, Atrioventricular Nodal Reentry, Tachycardia, Supraventricular, Vasomotor System

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