The DOI matches its Crossref record, with a small difference in title or year; 13 of the 13 references it cites were found in a registry or an index.
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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Cites
Sutton, R., Brignole, M., Menozzi, C., Raviele, A., Alboni, P., Giani, P., & Moya, A. (2000) · Circulation · doi:10.1161/01.cir.102.3.294 · Cited by 407
Self-citationUse of an Extended Monitoring Strategy in Patients With Problematic Syncope
Krahn, A. D., Klein, G. J., Yee, R., Takle-Newhouse, T., & Norris, C. (1999) · Circulation · doi:10.1161/01.cir.99.3.406 · Cited by 360 · cited 11×
“Participating Centers and Investigators (number of patients in brackets) Ospedale S. Maria Nuova, Reggio Emilia: C. Menozzi, N. Bottoni (21); Ospedale Villa Maria, Piombino: S. Tognarini, S. Bechi (8); Hospital Clinico, Barcelona: L. Mont (7); Ospedali Riuniti, Lavagna: M. Brignole, P. Donateo, G. Gaggioli (6); Ospeda…”
BackgroundInfluentialRaviele, A., Menozzi, C., Brignole, M., Gasparini, G., Alboni, P., Musso, G., Lolli, G., Oddone, D., Dinelli, M., & Mureddu, R. (1995) · The American Journal of Cardiology · doi:10.1016/s0002-9149(99)80079-4 · Cited by 249
Self-citationRisk Factors for Syncope Recurrence After a Positive Tilt-Table Test in Patients With Syncope
Sheldon, R. S., Rose, S., Flanagan, P., Koshman, M. L., & Killam, S. (1996) · Circulation · doi:10.1161/01.cir.93.5.973 · Cited by 231
The etiology of syncope in patients with negative tilt table and electrophysiological testing
Krahn, A. D., Klein, G. J., Norris, C., & Yee, R. (1995) · Circulation · doi:10.1161/01.cir.92.7.1819 · Cited by 215
Raviele, A., Brignole, M., Sutton, R., Alboni, P., Giani, P., Menozzi, C., & Moya, A. (1999) · Circulation · doi:10.1161/01.cir.99.11.1452 · Cited by 201
Self-citationLeitch, J. W., Klein, G. J., Yee, R., Leather, R. A., & Kim, Y. H. (1992) · Circulation · doi:10.1161/01.cir.85.3.1064 · Cited by 171
Diagnostic accuracy of a low-dose isoproterenol head-up tilt protocol
Morillo, C. A., Klein, G. J., Zandri, S., & Yee, R. K. (1995) · American Heart Journal · doi:10.1016/0002-8703(95)90110-8 · Cited by 155
Diagnostic and prognostic implicatioins of recurrences in patients with syncope
Kapoor, W. N., Peterson, J., Wieand, H. S., & Karpf, M. (1987) · The American Journal of Medicine · doi:10.1016/0002-9343(87)90901-6 · Cited by 126
Heart Rhythm During Syncope and Presyncope: Results of Implantable Loop Recorders
Nierop, P. R., van Mechelen, R., ELSÄCKER, A. V., LUIJTEN, R. H. M., & Elhendy, A. A. (2000) · Pacing and Clinical Electrophysiology · doi:10.1046/j.1460-9592.2000.01532.x · Cited by 86
Research works printed but not linked: 7
- 10.1161/circ.99.3.406 · DOI
- 10.1161/circ.93.5.973 · DOI
- 10.1161/circ.102.3.294 · DOI
- 10.1161/circ.99.11.1452 · DOI
- 10.1161/circ.85.3.1537103 · DOI
- 10.1161/circ.92.7.1819 · DOI
- Alboni P, Dinelli M, Raviele A, et al. Is a second tilt test useful in patients with unexplained syncope? Eur J Cardiac Pacing Electrophysiol. 1995; 5: 292–295.
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Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), societies, E. B. T. F., European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp298 · Cited by 2,040
Self-citation2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya, A., de Lange, F. J., Deharo, J.-C., Elliott, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martín, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy037 · Cited by 1,951
Self-citationSheldon, R. S., Grubb, B. P., Olshansky, B., Shen, W.-K., Calkins, H., Brignole, M., Raj, S. R., Krahn, A. D., Morillo, C. A., Stewart, J. M., et al. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.03.029 · Cited by 1,013
Self-citationGuidelines for cardiac pacing and cardiac resynchronization therapy
Vardas, P. E., Auricchio, A., Blanc, J., Daubert, J., Drexler, H., Ector, H., Gasparini, M., Linde, C. M., Morgado, F. B., Oto, A., et al. (2007) · European Heart Journal · doi:10.1093/eurheartj/ehm305 · Cited by 895
Self-citationGuidelines on Management (diagnosis and treatment) of syncope ? update 2004
Brignole, M., Alboni, P., Benditt, D. G., Bergfeldt, L., Blanc, J., Thomsen, P. E. B., van Dijk, J. G., Fitzpatrick, A. P., Hohnloser, S. H., Janousek, J., et al. (2004) · EP Europace · doi:10.1016/j.eupc.2004.08.008 · Cited by 650
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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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