The Experts below are selected from a list of 72930 Experts worldwide ranked by ideXlab platform
Michele Brignole - One of the best experts on this subject based on the ideXlab platform.
-
Adenosine hypersensitivity and atrioventricular block
Herzschrittmachertherapie + Elektrophysiologie, 2018Co-Authors: Jeanclaude Deharo, Michele Brignole, Régis GuieuAbstract:Adenosin ist eine allgemein vorkommende Verbindung, die unter vielen physiologischen wie auch pathologischen Bedingungen freigesetzt wird und kardiovaskuläre Effekte hat, unter anderem auch kardioinhibitorische und vasodilatatorische. Es ist belegt, dass Adenosin als wichtiger Modulator in Bezug auf verschiedene Synkopeformen fungiert. Bei Patienten mit chronisch niedrigen Adenosinplasmaspiegeln kann eine transiente Freisetzung von endogenem Adenosin ausreichend sein, um die Erregungsleitung im atrioventrikulären (AV) Knoten zu blockieren und eine anhaltende Asystolie hervorzurufen. Umgekehrt hat die Adenosinfreisetzung bei chronisch hohen Plasmaspiegeln eine vasodepressorische Wirkung. Unterschiedliche purinerge Profile von Patienten mit Synkope sind in jüngerer Zeit mit dem klinischen Bild in Beziehung gebracht worden: Patienten mit niedrigem Adenosinspiegel neigen zu Asystolie und können einen idiopathischen AV-Block, ein Karotissinussyndrom oder eine Synkope ohne oder mit sehr kurzen Prodromen und normalem Herzen aufweisen; Patienten mit hohem Adenosinspiegel neigen zu Vasodilatation und zeigen vasovagale Synkopen. Diese pathophysiologische Klassifikation könnte von therapeutischer Relevanz sein. Adenosine is a ubiquitous substance that is released under several physiological and pathological conditions and has cardiovascular effects including cardioinhibition and vasodilation. It has been shown to be an important modulator implicated in several forms of Syncope. In patients with chronic low plasma levels of adenosine, a transient release of endogenous adenosine can be sufficient to block conduction in the atrioventricular node and induce prolonged asystole; conversely, when plasma adenosine levels are chronically high, adenosine release is responsible for vasodepression. Distinct purinergic profiles in patients presenting with Syncope have recently been correlated with the clinical presentation: “low-adenosine patients,” prone to asystole, may present with idiopathic atrioventricular block, carotid sinus syndrome, or Syncope with no or very brief prodromes and normal heart; “high-adenosine patients,” prone to vasodilation, experience vasovagal Syncope. This pathophysiological classification may have therapeutic implications.
-
a randomized double blind placebo controlled study of permanent cardiac pacing for the treatment of recurrent tilt induced vasovagal Syncope the vasovagal Syncope and pacing trial synpace
European Heart Journal, 2004Co-Authors: Antonio Raviele, Carlo Menozzi, Richard Sutton, Franco Giada, Giancarlo Speca, Serafino Orazi, G Gasparini, Michele BrignoleAbstract:Aims Recently, some studies revealed the efficacy of pacemaker implantation in decreasing recurrences in patients with vasovagal Syncope. As these studies were not blinded or placebo-controlled, the benefits observed might have been due to a bias in the assessment of outcomes or to a placebo effect of the pacemaker. We performed a randomized, double-blind, placebo-controlled study in order to ascertain if pacing therapy reduces the risk of Syncope relapse. Methods and results Twenty-nine patients (53±16 years; 19 women) with severe recurrent tilt-induced vasovagal Syncope (median 12 Syncopes in the lifetime) and 1 syncopal relapse after head-up tilt testing underwent implantation of a pacemaker, and were randomized to pacemaker ON or to pacemaker OFF. During a median of 715 days of follow-up, 8 (50%) patients randomized to pacemaker ON had recurrence of Syncope compared to 5 (38%) of patients randomized to pacemaker OFF ( p =n.s.); the median time to first Syncope was longer in the pacemaker ON than in pacemaker OFF group, although not significantly so (97 [38–144] vs 20 [4–302] days; p =0.38). There was also no significant difference in the subgroups of patients who had had a mixed response and in those who had had an asystolic response during head-up tilt testing. Conclusion Our data were unable to show a superiority of active pacing versus inactive pacing in preventing syncopal recurrence in patients with severe recurrent tilt-induced vasovagal Syncope.
-
Efficacy and feasibility of isometric arm counter-pressure manoeuvres to abort impending vasovagal Syncope during real life.
Europace, 2004Co-Authors: Francesco Croci, Daniele Oddone, Paolo Donateo, Enrico Puggioni, Michele Brignole, Carlo Menozzi, Alberto Solano, Gino LolliAbstract:Aims Isometric arm exercises are able to increase blood pressure during the phase of impending vasovagal Syncope. We evaluated their efficacy and feasibility during daily life in a group of 29 consecutive patients affected by vasovagal Syncopes. Methods The patients were trained to use arm tensing and/or handgrip in case of occurrence of symptoms of impending Syncope. Results During 14±6 months of follow-up, 260 episodes of impending Syncope were reported by 19 patients; the manoeuvres were self-administered by these patients in 98% of cases and were able to abort Syncope in 99.6% of cases. Overall, 5 episodes of Syncope occurred in 5 patients (17%), in 4 cases without and in 1 with activation of the manoeuvres. Syncope recurred in 4 (40%) of 10 patients aged >65 years versus only 1 (5%) of 19 patients aged ≤65 years, p =0.03. The non-responders had more episodes of impending Syncope than responders (37±32 vs 3±4, p =0.001). Among 19 clinical variables, age in years was the only significant predictor of syncopal recurrence. No patients had injury or other adverse morbidity related to the relapses. Conclusions Isometric arm counter-pressure manoeuvres are able to abort impending vasovagal Syncope in most patients aged ≤65 years. Arm counter-pressure manoeuvres are feasible, safe and well accepted by the patients in the daily life.
-
dual chamber pacing in the treatment of neurally mediated tilt positive cardioinhibitory Syncope pacemaker versus no therapy a multicenter randomized study
Circulation, 2000Co-Authors: Richard Sutton, Paolo Alboni, Michele Brignole, Carlo Menozzi, Paolo Giani, Antonio Raviele, Angel MoyaAbstract:Background—This study was performed to compare implantation of a DDI pacemaker with rate hysteresis with no implant in respect to syncopal recurrences in patients with severe cardioinhibitory tilt-positive neurally mediated Syncope. Methods and Results—Forty-two patients from 18 European centers were randomized to receive a DDI pacemaker programmed to 80 bpm with hysteresis of 45 bpm (19 patients) or no pacemaker (23 patients). Inclusion criteria were ≥3 Syncopes over the last 2 years and a positive cardioinhibitory (Vasovagal Syncope International Study types 2A and 2B) response to tilt testing. The median number of previous syncopal episodes was 6; asystolic response to tilt testing was present in 36 patients (86%) (mean asystole, 13.9±10.2 seconds). All patients were followed up for a minimum of 1.0 years and a maximum of 6.7 years (mean, 3.7±2.2). One patient (5%) in the pacemaker arm experienced recurrence of Syncope compared with 14 patients (61%) in the no-pacemaker arm (P=0.0006). In the no-pacema...
-
Effect of Etilefrine in Preventing Syncopal Recurrence in Patients With Vasovagal Syncope
Circulation, 1999Co-Authors: Antonio Raviele, Paolo Alboni, Michele Brignole, Carlo Menozzi, Paolo Giani, Richard S Sutton, Angel MoyaAbstract:Background—Etilefrine is an α-agonist agent with a potent vasoconstrictor effect, which is potentially useful in preventing vasovagal Syncope by reducing venous pooling and/or by counteracting reflex arteriolar vasodilatation. The present multicenter, randomized, placebo-controlled study was designed to evaluate the efficacy of this drug for the long-term management of patients with recurrent vasovagal Syncope. Methods and Results—In the 20 participating centers, 126 patients with recurrent vasovagal Syncope (at least 3 episodes in the last 2 years) and a positive baseline head-up tilt response were randomly assigned to placebo (63 patients) or etilefrine at a dosage of 75 mg/d (63 patients) and were followed up for 1 year or until Syncope recurred. The primary end-point of the study was the first recurrence of Syncope. There were no differences between the 2 study groups in the patients’ baseline characteristics. During follow-up, the group treated with etilefrine had a similar incidence of first syncopa...
Carlo Menozzi - One of the best experts on this subject based on the ideXlab platform.
-
a randomized double blind placebo controlled study of permanent cardiac pacing for the treatment of recurrent tilt induced vasovagal Syncope the vasovagal Syncope and pacing trial synpace
European Heart Journal, 2004Co-Authors: Antonio Raviele, Carlo Menozzi, Richard Sutton, Franco Giada, Giancarlo Speca, Serafino Orazi, G Gasparini, Michele BrignoleAbstract:Aims Recently, some studies revealed the efficacy of pacemaker implantation in decreasing recurrences in patients with vasovagal Syncope. As these studies were not blinded or placebo-controlled, the benefits observed might have been due to a bias in the assessment of outcomes or to a placebo effect of the pacemaker. We performed a randomized, double-blind, placebo-controlled study in order to ascertain if pacing therapy reduces the risk of Syncope relapse. Methods and results Twenty-nine patients (53±16 years; 19 women) with severe recurrent tilt-induced vasovagal Syncope (median 12 Syncopes in the lifetime) and 1 syncopal relapse after head-up tilt testing underwent implantation of a pacemaker, and were randomized to pacemaker ON or to pacemaker OFF. During a median of 715 days of follow-up, 8 (50%) patients randomized to pacemaker ON had recurrence of Syncope compared to 5 (38%) of patients randomized to pacemaker OFF ( p =n.s.); the median time to first Syncope was longer in the pacemaker ON than in pacemaker OFF group, although not significantly so (97 [38–144] vs 20 [4–302] days; p =0.38). There was also no significant difference in the subgroups of patients who had had a mixed response and in those who had had an asystolic response during head-up tilt testing. Conclusion Our data were unable to show a superiority of active pacing versus inactive pacing in preventing syncopal recurrence in patients with severe recurrent tilt-induced vasovagal Syncope.
-
Efficacy and feasibility of isometric arm counter-pressure manoeuvres to abort impending vasovagal Syncope during real life.
Europace, 2004Co-Authors: Francesco Croci, Daniele Oddone, Paolo Donateo, Enrico Puggioni, Michele Brignole, Carlo Menozzi, Alberto Solano, Gino LolliAbstract:Aims Isometric arm exercises are able to increase blood pressure during the phase of impending vasovagal Syncope. We evaluated their efficacy and feasibility during daily life in a group of 29 consecutive patients affected by vasovagal Syncopes. Methods The patients were trained to use arm tensing and/or handgrip in case of occurrence of symptoms of impending Syncope. Results During 14±6 months of follow-up, 260 episodes of impending Syncope were reported by 19 patients; the manoeuvres were self-administered by these patients in 98% of cases and were able to abort Syncope in 99.6% of cases. Overall, 5 episodes of Syncope occurred in 5 patients (17%), in 4 cases without and in 1 with activation of the manoeuvres. Syncope recurred in 4 (40%) of 10 patients aged >65 years versus only 1 (5%) of 19 patients aged ≤65 years, p =0.03. The non-responders had more episodes of impending Syncope than responders (37±32 vs 3±4, p =0.001). Among 19 clinical variables, age in years was the only significant predictor of syncopal recurrence. No patients had injury or other adverse morbidity related to the relapses. Conclusions Isometric arm counter-pressure manoeuvres are able to abort impending vasovagal Syncope in most patients aged ≤65 years. Arm counter-pressure manoeuvres are feasible, safe and well accepted by the patients in the daily life.
-
dual chamber pacing in the treatment of neurally mediated tilt positive cardioinhibitory Syncope pacemaker versus no therapy a multicenter randomized study
Circulation, 2000Co-Authors: Richard Sutton, Paolo Alboni, Michele Brignole, Carlo Menozzi, Paolo Giani, Antonio Raviele, Angel MoyaAbstract:Background—This study was performed to compare implantation of a DDI pacemaker with rate hysteresis with no implant in respect to syncopal recurrences in patients with severe cardioinhibitory tilt-positive neurally mediated Syncope. Methods and Results—Forty-two patients from 18 European centers were randomized to receive a DDI pacemaker programmed to 80 bpm with hysteresis of 45 bpm (19 patients) or no pacemaker (23 patients). Inclusion criteria were ≥3 Syncopes over the last 2 years and a positive cardioinhibitory (Vasovagal Syncope International Study types 2A and 2B) response to tilt testing. The median number of previous syncopal episodes was 6; asystolic response to tilt testing was present in 36 patients (86%) (mean asystole, 13.9±10.2 seconds). All patients were followed up for a minimum of 1.0 years and a maximum of 6.7 years (mean, 3.7±2.2). One patient (5%) in the pacemaker arm experienced recurrence of Syncope compared with 14 patients (61%) in the no-pacemaker arm (P=0.0006). In the no-pacema...
-
Effect of Etilefrine in Preventing Syncopal Recurrence in Patients With Vasovagal Syncope
Circulation, 1999Co-Authors: Antonio Raviele, Paolo Alboni, Michele Brignole, Carlo Menozzi, Paolo Giani, Richard S Sutton, Angel MoyaAbstract:Background—Etilefrine is an α-agonist agent with a potent vasoconstrictor effect, which is potentially useful in preventing vasovagal Syncope by reducing venous pooling and/or by counteracting reflex arteriolar vasodilatation. The present multicenter, randomized, placebo-controlled study was designed to evaluate the efficacy of this drug for the long-term management of patients with recurrent vasovagal Syncope. Methods and Results—In the 20 participating centers, 126 patients with recurrent vasovagal Syncope (at least 3 episodes in the last 2 years) and a positive baseline head-up tilt response were randomly assigned to placebo (63 patients) or etilefrine at a dosage of 75 mg/d (63 patients) and were followed up for 1 year or until Syncope recurred. The primary end-point of the study was the first recurrence of Syncope. There were no differences between the 2 study groups in the patients’ baseline characteristics. During follow-up, the group treated with etilefrine had a similar incidence of first syncopa...
-
carotid sinus massage eyeball compression and head up tilt test in patients with Syncope of uncertain origin and in healthy control subjects
American Heart Journal, 1991Co-Authors: Michele Brignole, Daniele Oddone, Carlo Menozzi, Gino Lolli, Lorella Gianfranchi, Antonio BertullaAbstract:Abstract To verify the role of abnormal neural mechanisms in unexplained Syncopes, we evaluated the results of carotid sinus massage (CSM), eyeball compression (EBC), and head-up tilt test (HUT) in the basal state (B) and during isoproterenol infusion (ISO) in: (1) 100 consecutive patients affected by Syncope which, despite careful cardiovascular and neurologic examination, was of uncertain origin (age 60 ± 18 years; 54 men) and (2) 25 healthy subjects matched 4:1 with the patients of the previous group. All the patients underwent CSM and EBC in the supine and standing position for 10 seconds and HUT at 60 degrees for 60 minutes; if HUT-B was negative (68 cases), it was repeated during ISO (1 to 5 μg/min) infusion. In the patients with uncertain Syncope, spontaneous symptoms were fully reproduced in 49%, 16%, 32%, and 16% of cases respectively by means of CSM, EBC, HUT, and HUT-ISO; overall positivity for at least one test was observed in 79% of cases. The results of CSM, EBC, or HUT-ISO were linked to age, sex, and underlying heart disease. In the healthy subjects, Syncope was induced by CSM, EBC, HUT, and HUT-ISO in one case each; overall positivity was 16%. In conclusion, neural reflex induction tests reproduced spontaneous symptoms in most patients affected by uncertain Syncope, while they evoked normal responses in most healthy subjects. Therefore on the basis of results of induction tests, the diagnosis of neurally mediated Syncope can be ascribed to most patients affected by Syncope of uncertain origin.
Angel Moya - One of the best experts on this subject based on the ideXlab platform.
-
Syncope and bundle branch block
Herzschrittmachertherapie + Elektrophysiologie, 2018Co-Authors: Angel Moya, Nuria Rivas-gandara, Jordi Perez-rodón, Jaume Franciso-pascual, Alba Santos-ortega, Patricia Fumero, Ivo Roca-luqueAbstract:Syncope and bundle branch block are reviewed, addressing their specific clinical characteristics, natural history, initial diagnostic approach and the role and limitations of different diagnostic tests with a special focus on electrophysiological studies and implantable loop recorders. A critical review of the different published strategies to be followed in these patients is made and finally an algorithm of how to manage these patients is proposed. Synkope und Schenkelblock werden beurteilt in Hinblick auf deren spezifische klinische Charakteristika, natürlichen Verlauf und Verfahren zur initialen Diagnostik sowie die Bedeutung und Limitierungen verschiedener diagnostischer Untersuchungen mit speziellem Fokus auf elektrophysiologische Studien und implantierbare Loop-Rekorder. Es erfolgt eine kritische Beurteilung der unterschiedlichen publizierten Strategien bei diesen Patienten, und abschließend wird ein Algorithmus zur Behandlung solcher Patienten vorgeschlagen.
-
dual chamber pacing in the treatment of neurally mediated tilt positive cardioinhibitory Syncope pacemaker versus no therapy a multicenter randomized study
Circulation, 2000Co-Authors: Richard Sutton, Paolo Alboni, Michele Brignole, Carlo Menozzi, Paolo Giani, Antonio Raviele, Angel MoyaAbstract:Background—This study was performed to compare implantation of a DDI pacemaker with rate hysteresis with no implant in respect to syncopal recurrences in patients with severe cardioinhibitory tilt-positive neurally mediated Syncope. Methods and Results—Forty-two patients from 18 European centers were randomized to receive a DDI pacemaker programmed to 80 bpm with hysteresis of 45 bpm (19 patients) or no pacemaker (23 patients). Inclusion criteria were ≥3 Syncopes over the last 2 years and a positive cardioinhibitory (Vasovagal Syncope International Study types 2A and 2B) response to tilt testing. The median number of previous syncopal episodes was 6; asystolic response to tilt testing was present in 36 patients (86%) (mean asystole, 13.9±10.2 seconds). All patients were followed up for a minimum of 1.0 years and a maximum of 6.7 years (mean, 3.7±2.2). One patient (5%) in the pacemaker arm experienced recurrence of Syncope compared with 14 patients (61%) in the no-pacemaker arm (P=0.0006). In the no-pacema...
-
Effect of Etilefrine in Preventing Syncopal Recurrence in Patients With Vasovagal Syncope
Circulation, 1999Co-Authors: Antonio Raviele, Paolo Alboni, Michele Brignole, Carlo Menozzi, Paolo Giani, Richard S Sutton, Angel MoyaAbstract:Background—Etilefrine is an α-agonist agent with a potent vasoconstrictor effect, which is potentially useful in preventing vasovagal Syncope by reducing venous pooling and/or by counteracting reflex arteriolar vasodilatation. The present multicenter, randomized, placebo-controlled study was designed to evaluate the efficacy of this drug for the long-term management of patients with recurrent vasovagal Syncope. Methods and Results—In the 20 participating centers, 126 patients with recurrent vasovagal Syncope (at least 3 episodes in the last 2 years) and a positive baseline head-up tilt response were randomly assigned to placebo (63 patients) or etilefrine at a dosage of 75 mg/d (63 patients) and were followed up for 1 year or until Syncope recurred. The primary end-point of the study was the first recurrence of Syncope. There were no differences between the 2 study groups in the patients’ baseline characteristics. During follow-up, the group treated with etilefrine had a similar incidence of first syncopa...
Antonio Raviele - One of the best experts on this subject based on the ideXlab platform.
-
a randomized double blind placebo controlled study of permanent cardiac pacing for the treatment of recurrent tilt induced vasovagal Syncope the vasovagal Syncope and pacing trial synpace
European Heart Journal, 2004Co-Authors: Antonio Raviele, Carlo Menozzi, Richard Sutton, Franco Giada, Giancarlo Speca, Serafino Orazi, G Gasparini, Michele BrignoleAbstract:Aims Recently, some studies revealed the efficacy of pacemaker implantation in decreasing recurrences in patients with vasovagal Syncope. As these studies were not blinded or placebo-controlled, the benefits observed might have been due to a bias in the assessment of outcomes or to a placebo effect of the pacemaker. We performed a randomized, double-blind, placebo-controlled study in order to ascertain if pacing therapy reduces the risk of Syncope relapse. Methods and results Twenty-nine patients (53±16 years; 19 women) with severe recurrent tilt-induced vasovagal Syncope (median 12 Syncopes in the lifetime) and 1 syncopal relapse after head-up tilt testing underwent implantation of a pacemaker, and were randomized to pacemaker ON or to pacemaker OFF. During a median of 715 days of follow-up, 8 (50%) patients randomized to pacemaker ON had recurrence of Syncope compared to 5 (38%) of patients randomized to pacemaker OFF ( p =n.s.); the median time to first Syncope was longer in the pacemaker ON than in pacemaker OFF group, although not significantly so (97 [38–144] vs 20 [4–302] days; p =0.38). There was also no significant difference in the subgroups of patients who had had a mixed response and in those who had had an asystolic response during head-up tilt testing. Conclusion Our data were unable to show a superiority of active pacing versus inactive pacing in preventing syncopal recurrence in patients with severe recurrent tilt-induced vasovagal Syncope.
-
dual chamber pacing in the treatment of neurally mediated tilt positive cardioinhibitory Syncope pacemaker versus no therapy a multicenter randomized study
Circulation, 2000Co-Authors: Richard Sutton, Paolo Alboni, Michele Brignole, Carlo Menozzi, Paolo Giani, Antonio Raviele, Angel MoyaAbstract:Background—This study was performed to compare implantation of a DDI pacemaker with rate hysteresis with no implant in respect to syncopal recurrences in patients with severe cardioinhibitory tilt-positive neurally mediated Syncope. Methods and Results—Forty-two patients from 18 European centers were randomized to receive a DDI pacemaker programmed to 80 bpm with hysteresis of 45 bpm (19 patients) or no pacemaker (23 patients). Inclusion criteria were ≥3 Syncopes over the last 2 years and a positive cardioinhibitory (Vasovagal Syncope International Study types 2A and 2B) response to tilt testing. The median number of previous syncopal episodes was 6; asystolic response to tilt testing was present in 36 patients (86%) (mean asystole, 13.9±10.2 seconds). All patients were followed up for a minimum of 1.0 years and a maximum of 6.7 years (mean, 3.7±2.2). One patient (5%) in the pacemaker arm experienced recurrence of Syncope compared with 14 patients (61%) in the no-pacemaker arm (P=0.0006). In the no-pacema...
-
Effect of Etilefrine in Preventing Syncopal Recurrence in Patients With Vasovagal Syncope
Circulation, 1999Co-Authors: Antonio Raviele, Paolo Alboni, Michele Brignole, Carlo Menozzi, Paolo Giani, Richard S Sutton, Angel MoyaAbstract:Background—Etilefrine is an α-agonist agent with a potent vasoconstrictor effect, which is potentially useful in preventing vasovagal Syncope by reducing venous pooling and/or by counteracting reflex arteriolar vasodilatation. The present multicenter, randomized, placebo-controlled study was designed to evaluate the efficacy of this drug for the long-term management of patients with recurrent vasovagal Syncope. Methods and Results—In the 20 participating centers, 126 patients with recurrent vasovagal Syncope (at least 3 episodes in the last 2 years) and a positive baseline head-up tilt response were randomly assigned to placebo (63 patients) or etilefrine at a dosage of 75 mg/d (63 patients) and were followed up for 1 year or until Syncope recurred. The primary end-point of the study was the first recurrence of Syncope. There were no differences between the 2 study groups in the patients’ baseline characteristics. During follow-up, the group treated with etilefrine had a similar incidence of first syncopa...
Antoni Martinezrubio - One of the best experts on this subject based on the ideXlab platform.
-
tilt table test state of the art
Indian pacing and electrophysiology journal, 2003Co-Authors: Gonzalo Baronesquivias, Antoni MartinezrubioAbstract:The loss of consciousness has been a subject of wonder and uncertainty in humans, and for this reason it has been the object of medical investigation since the beginning of time. Even actually, it is certainly an unresolved clinical problem. Many centuries ago, complicated exorcisms and remedies were used on these unfortunate patients, who upon regaining consciousness would find themselves soaked in miraculous liquids, ingesting curative potions, and often on the way to be burned accused of being possessed. In the seventeen century, physicians began to relate loss of consciousness and haemodinamic changes. William Harvey was perhaps the first to describe a circulatory response (vasovagal reaction) during a phlebotomy in the year 1628: “...Yet it fear or any other cause, or something do intervene through passion of the mind, so that the heart do beat more faintly, the blood will be no means pass through but drop after drop…”1. During the nineteenth century, loss of consciousness was the object of studies and research, and the vagally mediated cardioinhibition, as a primary cause, was noted by Foster who proposed that profound bradycardia diminished cerebral perfusion to a level inadequate to maintain consciousness2. At this time, it was reported the first use of the tilt-table test3. Commonly referred to as fainting or loss of consciousness, from last century the preferred medical term is Syncope, which itself is derived from the Greek term “syncoptein” meaning “to cut short”. Syncope is defined as the sudden loss of consciousness and postural tone with spontaneous recovery. In 1907, Gowers was the first person to use the term vasovagal Syncope4. In 1918 was published the work in which Cotton and Lewis described for the first time the clinical characteristics that are still used today to recognize the syncopal reaction5. However, it was not till 1932 when Lewis described this reaction as being characterized by a combination of bradycardia, hypotension, and Syncope, and he coined the term vasovagal Syncope for the first time6.
-
long term outcome of patients with asystole induced by head up tilt test
European Heart Journal, 2002Co-Authors: Gonzalo Baronesquivias, Alonso Pedrote, Juan I. Valle, José Burgos, Jose Manuel Maillo Fernandez, Aurelio Cayuela, F. Morales, M Fernandez, Eduardo Arana, Antoni MartinezrubioAbstract:Aims To analyse the long-term outcome of the largest reported cohort of patients presenting asystole during head-up tilt test. Methods and results Since 1990, 1322 patients with Syncope of unknown origin have undergone tilt-table testing. Of those, 330 patients (24 X 9%) presented an abnormal response (Syncope or pre-Syncope). Furthermore, 58 of those patients (17 X 5%) suffered a period of asystole (> or = 3000 ms) during the test. Asystole (median (interquartile range)) lasted 10 (4, 19 X 2) s (range 3-90). Two different protocols (angles) of tilting (Westminster (60 degrees) n=1124; isoproterenol (80 degrees) n=198)) influenced the time to the syncopal episode (13 (6 X 5, 20 X 5) vs 2 (1, 6 X 5) min, P=0,0005) but not the duration of the asystole. During this period, therapy for asystole featured three different stages: first patients were treated with pacemakers; later drug therapy (metoprolol and/or etilefrine) was recommended; lastly (from 1995), no specific treatment was given. In a cohort age- and gender-matched study, those patients without were compared to those with asystole in a 2:1 basis. During 40 X 7 months of follow-up (17 X 7, 66 X 8), 12 patients (20 X 6%) with asystole had syncopal recurrences. Furthermore, 34 patients (28 X 8%) without asystole presented syncopal episodes during a follow-up of 51 X 6 months (29 X 3, 73 X 1) (P=ns). The Kaplan-Meier analysis in patients with and without asystole showed a mean time free of recurrence of 92 X 6 +/- 6 months vs 82 X 6 +/- 4 X 7 months (P=ns). The previous number of Syncopes had a significant relationship with recurrences (P=0 X 002), but not therapy. There were no cardiac related deaths. Conclusions (1) Asystole during head-up tilt test does not imply a malignant outcome and Syncope recurrence is low; (2) pacemaker or drug therapy do not significantly influence outcome which correlates to the previous number of syncopal episodes but not to gender, age, asystole occurrence, asystole duration and timing to asystole during head-up tilt test; (3) tilting protocol (angle) might influence time to and incidence of asystole during head-up tilt test.
