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Mechanism of Syncope in Patients With Isolated Syncope and in Patients With Tilt-Positive Syncope
Abstract
Background Because of its episodic behavior, the correlation of spontaneous syncope with an abnormal finding can be considered a reference standard. Methods and Results We inserted an implantable loop recorder in 111 patients with syncope, absence of significant structural heart disease, and a normal ECG; tilt-testing was negative in 82 (isolated syncope) and positive in 29 (tilt-positive). The patients had had ≥3 episodes of syncope in the previous 2 years and were followed up for 3 to 15 months. Results were similar in the isolated syncope group and the tilt-positive group: syncope recurred in 28 (34%) and 10 patients (34%), respectively, and electrocardiographic correlation was found in 24 (23%) and 8 (28%) patients, respectively. The most frequent finding, which was recorded in 46% and 62% of patients, respectively, was one or more prolonged asystolic pauses, mainly due to sinus arrest, preceded for a few minutes by progressive bradycardia or progressive tachycardia-bradycardia. Bradycardia without pauses was observed in 8% and 12% of cases, respectively. The remaining patients had normal sinus rhythm or sinus tachycardia, except for one, who had ectopic atrial tachycardia. In the tilt-positive group, an asystolic syncope was also recorded when the type of response to tilt-testing was vasodepressor or mixed. Presyncopal episodes were never characterized by asystolic pauses; normal sinus rhythm was the most frequent finding. Conclusions Homogeneous findings were observed during syncope. In most patients, the likely cause was neurally-mediated, and the most frequent mechanism was a bradycardic reflex. In the other cases, a normal sinus rhythm was frequently recorded. Presyncope was not an accurate surrogate for syncope in establishing a diagnosis.
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“These patients appear to benefit from permanent pacing.105–112”
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 [107]
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“However, the devices have been shown to improve care in only the subset of patients who are older, have asystole documented on the ILR, and whose tilt test results were negative, probably because many of the diagnoses are of vasovagal syncope.”
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 [107]
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Metadata
- Authors
- Moya, A., Brignole, M., Menozzi, C., Garcia-Civera, R., Tognarini, S., Mont, L., Botto, G., Giada, F., Cornacchia, D., & on behalf of the International Study on Syncope of Uncertain Etiology (ISSUE) Investigators
- Affiliations
- From the Departments of Cardiology of Hospital Vall d’Hebron, Barcelona, Spain (A.M.); Ospedali Riuniti, Lavagna, Italy (M.B.); Ospedale S Maria Nuova, Reggio Emilia, Italy (C.M.); Hospital Clinico Universitario, Valencia, Spain (R.G.-C.); Ospedale Villa Maria, Piombino, Italy (S.T.); Hospital Clinico, Barcelona, Spain (L.M.); Ospedale Umberto I, Mestre, Italy (F.G.); Ospedale S. Anna, Como, Italy (G.B.); Ospedale per gli Infermi, Faenza, Italy (D.C.).
- Hospital Clínico Universitario de Valencia (ES)
- Venue
- Circulation
- Published
- 2001-09-11
- Volume
- 104
- Issue
- 11
- Pages
- 1261-1267
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2135058841
- Cited by
- 378
- References
- 13
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 7 · 2023: 4 · 2022: 7 · 2021: 13 · 2020: 8 · 2019: 3 · 2018: 13 · 2017: 21 · 2016: 16 · 2015: 9 · 2014: 22 · 2013: 27 · 2012: 18
- FWCI
- 19.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (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
- syncope, implantable loop recorder, sinus arrest, neurally mediated syncope, vasodepressor syncope, presyncope, syncope recurrence, syncope mechanism
- MeSH terms
- Adult, Aged, Aged, 80 and over, Bradycardia, Cardiac Pacing, Artificial, Electrocardiography, Female, Humans, Male, Middle Aged, Recurrence, Syncope, Tachycardia, Tilt-Table Test
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