Document Detail


Mechanism of syncope in patients with isolated syncope and in patients with tilt-positive syncope.
MedLine Citation:
PMID:  11551877     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
A Moya; M Brignole; C Menozzi; R Garcia-Civera; S Tognarini; L Mont; G Botto; F Giada; D Cornacchia;
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  104     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2001 Sep 
Date Detail:
Created Date:  2001-09-11     Completed Date:  2001-10-11     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1261-7     Citation Subset:  AIM; IM    
Affiliation:
Departments of Cardiology of Hospital Vall d'Hebron, Barcelona, Spain.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Bradycardia / physiopathology
Cardiac Pacing, Artificial
Electrocardiography
Female
Humans
Male
Middle Aged
Recurrence
Syncope / physiopathology*,  therapy
Tachycardia / physiopathology
Tilt-Table Test*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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