Document Detail


Prediction of vasovagal syncope from heart rate and blood pressure trend and variability: experience in 1,155 patients.
MedLine Citation:
PMID:  17954394     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Vasovagal syncope (VVS) is a complex fainting disorder commonly triggered by orthostatic stress. OBJECTIVE: We developed an algorithm for VVS prediction based on the joint assessment of RR interval (RR) and systolic blood pressure (SBP). METHODS: Simultaneous analysis of RR and SBP trends during head-up tilt as well as their variability represented by low-frequency power (LFRR and LFSBP) generated a cumulative risk that was compared with a predetermined VVS risk threshold. When cumulative risk exceeded the threshold, an alert was generated. Prediction time was the duration between the first alert and syncope. In the first 180 sec of head-up tilt, baseline values were established, following which VVS prediction was possible. An analysis was performed using 1,155 patients who had undergone head-up tilt for syncope: 759 tilt-positive and 396 tilt-negative patients. In the tilt-test protocol, at syncope or after 35 min, the patient was returned to supine. RESULTS: In tilt-positive patients, VVS was predicted in 719 of 759 patients (sensitivity 95%), whereas 29 false alarms were generated in 396 tilt-negative patients (specificity 93%). Prediction times varied from 0 to 30 min but were longer than 1 min in 49% of patients. CONCLUSION: Predicting impending syncope requires use of simultaneous blood pressure and heart rate, which may shorten diagnostic testing time, free patients from experiencing syncope during a diagnostic tilt-test, and have application in risk-guided tilt training and in an implanted device-to-trigger pacing intervention. The prospects for relieving patient discomfort are encouraging.
Authors:
Nathalie Virag; Richard Sutton; Rolf Vetter; Toby Markowitz; Mark Erickson
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-07-18
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  4     ISSN:  1547-5271     ISO Abbreviation:  Heart Rhythm     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-10-23     Completed Date:  2008-02-08     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1375-82     Citation Subset:  IM    
Affiliation:
Medtronic Europe, Tolochenaz, Switzerland. nathalie.virag@medtronic.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Algorithms
Autonomic Nervous System / physiopathology*
Blood Pressure*
Child
Child, Preschool
Female
Heart Rate*
Humans
Male
Middle Aged
Retrospective Studies
Risk Factors
Syncope, Vasovagal / diagnosis*,  physiopathology
Systole
Tilt-Table Test*
Time Factors
Comments/Corrections
Comment In:
Heart Rhythm. 2007 Nov;4(11):1383-4   [PMID:  17954395 ]

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


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