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Review

Management of vasovagal syncope: 2004

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Pages 915-923 | Published online: 10 Jan 2014

References

  • Savage DD, Corwin L, McGee DL, Kannel WB, Wolf PA. Epidemiologic features of isolated syncope: the Framingham Study. Stroke 16, 626–629 (1985).
  • Chen LY, Shen WK, Mahoney DW, Jacobsen SJ, Rodeheffer RJ. Prevalence of self-reported syncope: an epidemiologic study from Olmsted County, MN. J. Am. Coll Cardiol 39, A114–A115 (2002).
  • Day SC, Cook EF, Funkenstein H, Goldman L. Evaluation and outcome of emergency room patients with transient loss of consciousness. Am. J Med. 73, 15–23 (1982).
  • Almquist A, Goldenberg IF, Milstein S et al Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope. N Engl. J Med. 320, 346–351 (1989).
  • Abi-Samra F, Maloney JD, Fouad-Tarazi FM, Castle LW The usefulness of headup tilt testing and hemodynamic investigations in the workup of syncope of unknown origin. Pacing Clin. Electrophysiol 11, 1202–1214 (1988).
  • Waxman MB, Yao L, Cameron DA, Wald RW, Roseman J. Lsoproterenol induction of vasodepressor-type reaction in vasodepressor-prone persons. Am. J Cardiol 63,58–65 (1989).
  • Sheldon R, Rose S, Koshman ML. Comparison of patients with syncope of unknown cause having negative or positive tilt-table tests. Am. J Cardiol 80,581–585 (1997).
  • Grimm W Degenhardt M, Hoffman J, Menz V, Wirths A, Maisch B. Syncope recurrence can better be predicted by history than by headup tilt testing in untreated patients with suspected neurally mediated syncope. Eur. Heart J 18, 1465–1469 (1997).
  • Linzer M, Pontinen M, Gold DT, Divine GW, Felder A, Brooks WB. Impairment of physical and psychosocial function in recurrent syncope. J. Clin. Epidemiol 44, 1037–1043 (1991).
  • Linzer M, Gold DT, Pontinen M, Divine GW, Felder A, Brooks WB. Recurrent syncope as a chronic disease: preliminary validation of a disease-specific measure of functional impairment. J Gen. Intern. Med. 9,181–186 (1994).
  • Rose MS, Koshman ML, Spreng S, Sheldon R. The relationship between health-related quality of life and frequency of spells in patients with syncope. J. Clin. Epidemiol 53,1209-1216 pooy
  • Sheldon R, Rose S, Flanagan P, Koshman ML, Killam S. Risk factors for syncope recurrence after a positive tilt-table test in patients with syncope. Circulation 93, 973–981 (1996).
  • Natale A, Geiger MJ, Maglio C et al Recurrence of neurocardiogenic syncope without pharmacologic interventions. Am. Cardiol 77,1001–1003 (1996).
  • Rossen R, Kabat H, Anderson JP. Acute arrest of cerebral circulation in man. Arch. Neurol Psych. 50,510–528 (1943).
  • Hainsworth R. Syncope: what is the trigger? Heart89(2), 123–124 (2003).
  • Grubb BP, Kosinski DJ. Serotonin and syncope: an emerging connection? Eur. Cardiac Pacing Electrophysiol 5,306–314 (1995).
  • Kaufmann H, Hainsworth R. Why do we faint? Muscle Nerve 24,981–983 (2001).
  • ••Thoughtful assessment of currentconcepts of the physiology of vasovagal syncope.
  • Dietz NM, Halliwill JM, Spielmann JM et al. Sympathetic withdrawal and forearm vasodilation during vasovagal syncope in humans. J. App/. Physiol 82(6), 1785–1793 (1997).
  • Mosqueda-Garcia R, Furlan R, Tank J, Fernandez-Violante R. The elusive pathophysiology of neurally mediated syncope. Circulation 102 (23), 2898–2906 (2000).
  • Wieling W, Van Lieshout JJ, Hainsworth R. Extracellular fluid volume expansion in patients with posturally related syncope. Clin. Auton. Res. 12(4), 242–249 (2002).
  • Mosqueda-Garcia R, Furlan R, Fernandez- Violante R et al. Sympathetic and baroreceptor reflex function in neurally mediated syncope evoked by tilt. J. Clin. Invest. 99(11), 2736–2744 (1997).
  • Morillo CA, Eckberg DL, Ellenbogen KA et al. Vagal and sympathetic mechanisms in patients with orthostatic vasovagal syncope. Circulation 96,2509–2513 (1997).
  • •Elegant study that continues to provide useful information on the physiology of vasovagal syncope.
  • Bush VE, Wight VL, Brown CM, Hainsworth R. Vascular responses to orthostatic stress in patients with postural tachycardia syndrome (POTS), in patients with low orthostatic tolerance, and in asymptomatic controls. Clin. Auton. Res. 10(5), 279–284 (2000).
  • Claydon VE, Hainsworth R. Cerebral autoregulation during orthostatic stress in healthy controls and in patients with posturally related syncope. Clin. Auton. Res. 13(5), 321–329 (2003).
  • Mosqueda-Garcia R, Fernandez-Violante R, Tank J, Snell M, Cunningham G, Furlan R. Yohimbine in neurally mediated syncope. Pathophysiological implications. Clin. Invest. 102(10), 1824–1830 (1998).
  • Brignole M, Alboni P, Benditt D et al. Task Force on Syncope, European Society of Cardiology. Guidelines on management (diagnosis and treatment) of syncope. Eur. Heart J. 22(15), 1256–306 (2001).
  • •• Thoughtful and comprehensive review, which is an absolute must-read; if you had to pick one paper in the field, this is it.
  • Van Donselaar CA, Geerts AT, Meulstee J, Habbema JDF, Staal A. Reliability of the diagnosis of a first seizure. Neurology39, 267–271 (1989).
  • Calkins H, Shyr Y, Frumin H, Schork A, Morady E The value of the clinical history in the differentiation of syncope due to ventricular tachycardia, atrioventricular block, and neurocardiogenic syncope. Am. J Med. 98,365–373 (1995).
  • Alboni P, Brignole M, Menozzi C et al. Diagnostic value of history in patients with syncope with or without heart disease. J Am. Coll Cardiol 37, 1921–1928 (2001).
  • Sheldon R, Rose MS, Ritchie D et al. Historical criteria that distinguish syncope from seizures. J Am. Coll. Cardiol 40, 142–148 (2002).
  • •Reports a diagnostic score that separates syncope and seizures with high accuracy.
  • Sheldon R, Rose MS, Ritchie D, Koshman ML, Frenneaux M, Connolly SJ. Anamnestic diagnostic criteria for tilt-positive vasovagal syncope. Pacing Clin. Electrophysiol 23,643 (2000).
  • Sheldon RS, Rose MS, Fisher M et al Historical criteria for the causes of syncope in patients with structural heart disease. Pacing Clin. Electrophysiol 24, 627 (2001).
  • Kapoor WN. Diagnostic evaluation of syncope. Am. J. Med. 90,91–106 (1991).
  • Linzer M, Pritchett EL, Pontinen M, McCarthy E, Divine GW. Incremental diagnostic yield of loop electrocardiographic recorders in unexplained syncope. Am. J. Cardiol 66, 214–219 (1990).
  • Brown AP, Dawkins KD, Davies JG. Detection of arrhythmias: use of a patient-activated ambulatory electrocardiogram device with a solid-state memory loop. Br. Heart J. 58, 251–253 (1987).
  • Krahn AD, Klein GJ, Fitzpatrick A et al. Predicting the outcome of patients with unexplained syncope undergoing prolonged monitoring. Pacing Clin. Electrophysiol 25,37–41 (2002).
  • Krahn AD, Klein GJ, Yee R, Takle-Newhouse T, Norris C. Utility of an extended monitoring strategy in patients with problematic syncope. Circulation 99,406–410 (1999).
  • ••Randomized clinical trial of twodiagnostic strategies including tilt testing and implantable loop recorders.
  • Maya A, Brignole M, Menozzi C et al. Mechanism of syncope in patients with isolated syncope and in patients with tilt-positive syncope. Circulation 104, 1261–1267 (2001).
  • •Large, observational study contributing fundamental clinical insights into the role of bradycardia in vasovagal syncope, suggesting that many patients are profoundly bradycardic when they faint.
  • Krahn AD, Klein GJ, Yee R, Hoch JS, Skanes AC. Cost implications of testing strategy in patients with syncope: randomized assessment of syncope trial. J. Am. Coll Cardiol 42(3), 495–501 (2003).
  • Kenny RA, Ingram A, Bayliss J, Sutton R. Headup tilt: a useful test for investigating unexplained syncope. Lancetl (8494), 1352–1355 (1986).
  • Kapoor WN, Smith MA, Miller NL. Upright tilt testing in evaluating syncope: a comprehensive literature review. Am. J Med. 97,78–88 (1994).
  • Theodorakis GN, Livanis EG, Leftheriotis D, Flevari P, Markianos M, Kremastinos DT. Headup tilt test with clomipramine challenge in vasovagal syndrome — a new tilt-testing protocol. Eur Heart J. 24,658–663 (2003).
  • ••Extremely provocative report that might address the central mechanism of vasovagal syncope.
  • McIntosh SJ, Lawson J, Kenny RA. Intravenous cannulation alters the specificity of headup tilt testing for vasovagal syncope in elderly patients. Age Ageing63,58-65 (1994).
  • Sheldon RS, Koshman ML. A randomized study of tilt-test angle in patients with undiagnosed syncope. Can. J. Cardiol. 17, 1051–1057 (2001).
  • Sheldon RS, Killam SB. Methodology of isoproterenol — tilt-table testing in patients with syncope. J. Arn. Coll. Cardiol. 19, 773–779 (1992).
  • Delepine S, Prunier F, Leftheriotis G et al. Comparison between isoproterenol and nitroglycerin sensitized head-upright tilt in patient with unexplained syncope and negative or positive tilt response. Am. J Cardiol. 90,488–491 (2002).
  • El-Syed H, Hainsworth R. Salt supplement increases plasma volume and orthostatic tolerance in patients with unexplained syncope. Heart 75,134–140 (1996).
  • Mangru NN, Young ML, Mas MS, Chandar JS, Pearse La, Wolff GS. Usefulness of tilt-table test with normal saline infusion in management of neurocardiogenic syncope in children. Am. Heart J. 131,953–955 (1996).
  • Burklow TR, Moak JP, Bailley JJ, Makhlouf FT. Neurally mediated cardiac syncope: autonomic modulation after normal saline infusion. J. Arn. Coll. Cardiol. 33, 2059–2066 (1999).
  • Sheldon RS. Effects of aging on responses to isoproterenol tilt-table testing in patients with syncope. Am. J Cardiol. 74,459–463 (1994).
  • Sheldon RS, Sexton E, Koshman ML. Usefulness of clinical factors in predicting outcomes of passive tilt tests in patients with syncope. Am. J Cardiol. 85,360–364 (2000).
  • Maya A, Brignole M, Menozzi C et al. Mechanism of syncope in patients with isolated syncope and in patients with tilt-positive syncope. Circulation 104, 1261–1267 (2001).
  • White W, Sheldon RS, Ritchie D. Learning needs in patients with vasovagal syncope. Can. J. Cardiovasc. Nursing13(1), 26–30 (2003).
  • Cooper VL, Hainsworth R. Effects of dietary salt on orthostatic tolerance, blood pressure and baroreceptor sensitivity in patients with syncope. Cl/n. Auton. Res. 12,236–241 (2002).
  • Lu C-C, Diedrich A, Tung C-S et al. Water ingestion as prophylaxis against syncope. Circulation 108,2660–2665 (2003).
  • •Interesting demonstration of the ability of a large glass of water to prevent syncope.
  • Claydon VE, Hainsworth R. Salt supplementation improves orthostatic cerebral and peripheral vascular control in patients with syncope. Hypertension 43(4), 809–813 (2004).
  • Brignole M, Croci F, Menozzi C et al. Isometric arm counter-pressure maneuvers to abort impending vasovagal syncope. J. Am. Coll. Cordial. 40, 2053–2059 (2002).
  • •• This and the next paper both demonstrate the efficacy of physical counterpressure manoeuvres in preventing the progression of presyncope to syncope.
  • Krediet CT, van Dijk N, Linzer M, van Lieshout JJ, Wieling W Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation 106, 1684–1689 (2002).
  • •• Reports that simply crossing your legs prevents syncope.
  • Lee TM, Su SF, Chen MF, Liau CS, Lee YT. Usefulness of transdermal scopolamine for vasovagal syncope. Am. J Cordial. 78,480–482 (1996).
  • Raviele A, Brignole M, Sutton R et al.Effect of etilefrine in preventing syncopal recurrence in patients with vasovagal syncope: a double-blind, randomized, placebo-controlled trial. The Vasovagal Syncope International Study. Circulation 99,1452–1457 (1999).
  • Ward CR, Gray JC, Gilroy JJ, Kenny RA.Midodrine: a role in the management of neurocardiogenic syncope. Heart 79, 45–49 (1998).
  • Perez-Lugones A, Schweikert R, Pavia S et al. Usefulness of midodrine in patients with severely symptomatic neurocardiogenic syncope: a randomized control study. J. Cardiovasc. Electrophysiol. 12,935–938 (2001).
  • Kaufmann H, Saadia D, Voustianiouk A. Midodrine in neurally mediated syncope: a double-blind, randomized, crossover study. Ann. Neural. 52 (3), 342–345 (2002).
  • Di Girolamo E, Di Iorio C, Sabatini P, Leonzio L, Barbone C, Barsotti A. Effects of paroxetine hydrochloride, a selective serotonin re-uptake inhibitor, on refractory vasovagal syncope: a randomized, double-blind, placebo-controlled study. J. Am. Coll. Cordial. 33, 1227–1230 (1999).
  • •Well designed and well executed randomized clinical trial of serotonin-specific reuptake inhibitors in the prevention of vasovagal syncope.
  • Cox MM, Perlman BA, Mayor MR et al. Acute and long-term 13-adrenergic blockade for patients with neurocardiogenic syncope. Arn. Coll. Cardiol. 26,1293–1298 (1995).
  • Mahanonda N, Bhuripanyo K, Kangkagate C et al. Randomized double-blind, placebo-controlled trial of oral atenolol in patients with unexplained syncope and positive upright tilt-table test results. Am. Heart J 130,1250–1253 (1995).
  • Sheldon R, Rose S, Flanagan P, Koshman ML, Killam S. Effect of fl-blockers on the time to first syncope recurrence in patients after a positive isoproterenol tilt-table test. Am. J. Cordial. 78,536–539 (1996).
  • Madrid Aft Ortega J, Rebollo JG et al. Lack of efficacy of atenolol for the prevention of neurally mediated syncope in a highly symptomatic population: a prospective, double-blind, randomized and placebo-controlled study. J Am. Coll. Cordial. 37,554–559 (2001).
  • Sheldon RS, Raj S, Rose S, Connolly S. fl-blockers in syncope: the jury is still out. Arn. Coll. Cardiol. 38,7 (2001).
  • Sheldon R, Rose S, Connolly S. Prevention Of Syncope Trial (POST): a randomized clinical trial of fl-blocker in the prevention of vasovagal syncope; rationale and study design. Europace 5,71–75 (2003).
  • Schimmer BP, Parker KL. Adrenocorticotropic hormone: adrenocortical steroids and their synthetic analogs; inhibitors of the synthesis and actions of adrenocortical hormones. In: Goodman and Gilman's The Pharmacological Basis of Therapeutics. Hardman JG, Limbird LE, Gilman AG (Eds). McGraw-Hill, NY, USA, 1649–1677 (2001).
  • Balaji S, Oslizlok PC, Allen MC, McKay CA, Gillette PC. Neurocardiogenic syncope in children with a normal heart. J Am. Coll. Cordial. 23,779–785 (1994).
  • Scott WA, Pongiglione G, Bromberg BI et al. Randomized comparison of atenolol and fludrocortisone acetate in the treatment of pediatric neurally mediated syncope. Am. Cardiol. 76,400–402 (1995).
  • da Costa D, McIntosh S, Kenny RA. Benefits of fludrocortisone in the treatment of symptomatic vasodepressor carotid sinus syndrome. Br. Heartj 69, 308–310 (1993).
  • Petersen ME, Chamberlain-Webber R, Fitzpatrick AP, Ingram A, Williams T, Sutton R. Permanent pacing for cardioinhibitory malignant vasovagal syndrome. Br. Heartj 71,274–281 (1994).
  • Benditt DG, Sutton R, Gammage M, Fetter J, Markowitz T, and the Rate-drop Response Investigators. Clinical experience with Thera DR rate drop response pacing algorithm in carotid sinus syndrome and vasovagal syncope. Pacing Clin. Electrophysiol. 20,832–839 (1997).
  • Connolly SJ, Sheldon R, Roberts RS, Gent M. The North American Vasovagal Pacemaker Study (VPS). A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. I Am. Coll. Cardiol. 33,16–20 (1999).
  • Sutton R, Brignole M, Menozzi C et al Dual-chamber pacing in the treatment of neurally mediated tilt-positive cardioinhibitory syncope: pacemaker versus no therapy: a multicenter, randomized study. The VAsovagal Syncope International Study (VASIS) Investigators. Circulation 102,294–299 (2000).
  • Ammirati F, Colivicchi F, Santini M. Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope: a multicenter, randomized, controlled trial. Circulation 104,52–57 (2001).
  • Connolly SJ, Sheldon R, Thorpe KE et al. Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope: second Vasovagal Pacemaker Study (VPS II): a randomized trial. I Am. Med. Assoc. 289,2224–2229 (2003).
  • ••One of a few placebo-controlledstudies of pacemaker efficacy, and is the landmark study of pacing and vasovagal syncope.

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