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Syncope
Kinds of Syncope Selected AbstractsTHE INVESTIGATION OF SYNCOPE IN OLDER PATIENTSJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2007Henry Woodford BSc No abstract is available for this article. [source] EXERCISE-RELATED SYNCOPE INDUCED BY VASODILATOR THERAPY IN AN ELDERLY HYPERTENSIVE PATIENTJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2005Akiyoshi Ogimoto MD No abstract is available for this article. [source] THE EVALUATION and TREATMENT OF SYNCOPE: A HANDBOOK FOR CLINICAL PRACTICEJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5-6 2004Padraic Grattan-Smith Dr No abstract is available for this article. [source] Experience With Implantable Loop Recorders for Recurrent Unexplained SyncopeCONGESTIVE HEART FAILURE, Issue 2008Michele Brignole MD Knowledge of what occurs during spontaneous syncope is the gold standard for evaluation. Initially, implantable loop recorders (ILRs) were used in patients with unexplained syncope at the end of unsuccessful full, conventional work-up. In pooled data regarding 247 patients, a correlation between syncope and electrocardiographic findings was found in 84 patients (34%); of these, 52% had a bradycardia or asystole at the time of the recorded event, 11% had tachycardia, and 37% had no arrhythmia. Presyncope-electrocardiography correlation was observed in another third of the patients; presyncope was much less likely to be associated with an arrhythmia than was syncope. The diagnostic yield was similar in patients with and without structural heart diseases and was higher in older than in younger patients. Recent studies showed that ILR implantation can be safely performed in an early phase of the diagnostic evaluation,provided that patients at risk for life-threatening events are carefully excluded,in the patients who have a severe presentation of syncope (because of high risk of trauma or high frequency of episodes) which can be a benefit of a mechanism-specific therapy. Congest Heart Fail. 2008;14:7,12. ©2008 Le Jacq [source] Usefulness of the Head-Upright Tilt Test for Distinguishing Syncope and Epilepsy in ChildrenEPILEPSIA, Issue 6 2001J. Eirís-Puñal Summary: ,Purpose: Episodic loss of consciousness in children, whether or not associated with hypertonia or short-duration clonic movements, presents a diagnostic challenge to the pediatrician and child neurologist. We provide some evidence of the usefulness of the head-upright tilt test for investigating the causes of transient loss of consciousness in children, and for distinguishing between syncope, convulsive syncope, and epilepsy. Methods: We studied nine children previously diagnosed as epileptic on the basis of compatible clinical events and epileptiform findings in routine EEGs who were treated over the long term with antiepileptic drugs, but whose clinical records suggested syncope or convulsive syncope rather than epilepsy on reevaluation. All subjects underwent head-upright tilt testing. Results: The tilt-test result was positive in all nine cases, with the patients reporting the same symptoms as in the previously considered epileptic attacks. Conclusions: Inadequate histories and misuse/overinterpretation of EEG results often lead to misdiagnosis of epilepsy in children. The head-upright tilt test is a useful and reliable diagnostic technique, allowing syncopal events to be induced and evaluated under controlled conditions. In a subset of patients, it may help to distinguish epilepsy from simple or convulsive syncope. [source] Vertigo, Dizziness, and Syncope in MigraineHEADACHE, Issue 6 2008Kiyokazu Kawabe MD No abstract is available for this article. [source] Syncope in an adolescent: a case of conflicting tests and dual pathologyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 11 2008S. Sen-Chowdhry First page of article [source] Paroxysmal High-Grade Atrioventricular Block and Syncope in a Previously Healthy Child: What is the Mechanism?JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2010RONALD J. KANTER M.D. No abstract is available for this article. [source] An Unusual Cause of Syncope in a Patient with an Internal Cardioverter DefibrillatorJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2009SLIM KACEM M.D. No abstract is available for this article. [source] Predicting Recurrence of Vasovagal Syncope: A Simple Risk Score for the Clinical RoutineJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2009MUHAMMET A. AYDIN M.D. Background: Predictors for recurrence of syncope are lacking in patients with vasovagal syncope. The aim of this study was to identify risk factors for recurrence of syncope and develop a simple prognostic risk score of clinical value. Methods: Two hundred seventy-six patients with a history of vasovagal syncope were prospectively followed for 2 years. Diagnosis of vasovagal syncope was based on clinical history and negative standard work-up. Inclusion in the study was independent from the result of the head-up tilt test, which was performed in all cases. Risk factors for syncope recurrence were evaluated by the Cox proportional hazards regression model and implemented in a risk score, which was validated with the log-rank test and an internal cross-validation. Results: The Cox-regression analysis identified the number of previous syncopal events, history of bronchial asthma, and female gender as predictors for syncope recurrence (all P < 0.05). In contrast, head-up tilt test response had no predictive value (P = 0.881). Developing a risk score, study patients were identified as having high (recurrence rate during 2 years of follow-up: 37.2%), intermediate (24.8%), and low (6.5%) risk for syncope recurrence (receiver operating characteristic [ROC] of score 0.83, P < 0.01; Log-rank test for event-free survival, P < 0.005). Conclusions: In patients with vasovagal syncope, risk of recurrence can be stratified and is predictable based on a simple risk score. [source] Hemodynamic Monitoring During Syncope: Utility and LimitationsJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2009MOHAMED H. HAMDAN M.D. [source] Flush After Syncope: Not Always an ArrhythmiaJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2006Ph.D., W. Wieling M.D. No abstract is available for this article. [source] Single-Stage Adenosine Tilt Testing in Patients with Unexplained SyncopeJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2004SUNEET MITTAL M.D. Introduction: We previously have shown that a 3-minute single-stage adenosine tilt test has a diagnostic yield comparable to a two-stage protocol consisting of a 30-minute drug-free tilt followed by a 15-minute isoproterenol tilt. In this study, we sought to further define the clinical utility of adenosine tilt testing in patients with unexplained syncope by prospectively evaluating test specificity and determining predictors of a positive test response. Methods and Results: The specificity of single-stage adenosine tilt testing was determined using 30 control subjects. To determine the diagnostic yield of this protocol, adenosine tilts were performed in 129 patients with unexplained syncope. The adenosine tilt test protocol had high specificity (100%) but a low overall diagnostic yield (18%). However, the yield was affected significantly by age. In patients ,40 years of age, the tilt test was positive in 15 (41%) of 37 patients, which was significantly greater than the yield in patients between the ages of 41 and 64 years (6/41 patients [15%], P = 0.012) and those ,65 years of age (2/41 patients [5%], P < 0.0001). Conclusion: These data support single-stage adenosine tilt testing in patients ,40 years of age because the diagnostic yield of the test is maximal in this group and the test can be completed in ,3 minutes. Conversely, the diagnostic yield of adenosine tilt testing in patients >40 years of age is low, suggesting that the clinical utility of this protocol is limited in these patients. (J Cardiovasc Electrophysiol, Vol. 15, pp. 1-4, June 2004) [source] Respiratory Changes in Vasovagal SyncopeJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2000ARVINDER S. KURBAAN M.D. Respiratory Changes in Vasovagal Syncope. introduction: Respiratory changes accompany the cardiovascular changes during head-up. tilt test-induced vasovagal syncope. Methods and Results: Using the 45-minute 60° head-up Westminster protocol, 29 patients were studied (mean age 53.9 ± 20.0 years; 19 females). Two groups resulted: tilt-induced vasovagal syncope positive and negative. The cardiorespiratory parameters blood pressure (BP), heart rate (HR), tidal volume, and minute volume were measured. Comparisons of the cardiorespiratory parameters were made within the positive group and negative group, and then between the two groups. There were 14 in the positive group and 15 in the negative group. Baseline measurements were normalized to 1.0. Comparing the late tilt periods between the positive and negative groups, there were differences in BP (P < 0.002), HR (P < 0.002), tidal volume (P < 0.05), and minute volume (P < 0.002). In the positive group comparing early with late intervals: BP l.11 ± 0.09 versus 0.49 ± 0.17, P < 0.0001; HR 1.18 ± 0.12 versus 0.85 ±0.35, P < 0.009; tidal volume 1.39 ± 0.34 versus 2.17 ± 1.00, P < 0.015; and minute volume 1.24 ± 0.26 versus 3.3 ± 2.03, P < 0.0025. There were no comparable cardiorespiratory changes in the negative group. Conclusion: There were significant differences in the respiratory and cardiovascular parameters measured between those who were positive and those who were negative for tilt-induced vasovagal syncope. Within the positive group, in addition to the falls in HR and BP, there were significant increases in minute volume and tidal volume during late tilt. This suggests that there may be a role for respiratory sensors in vasovagal syncope that may permit earlier and hence possibly more effective therapy for selected patients. [source] Syncope in children with Tourette's syndrome treated with guanfacineMOVEMENT DISORDERS, Issue 3 2006Allison King MD Abstract We report on 4 children who experienced a syncopal episode while being treated with guanfacine without any other evident cause. Syncope appears to be an uncommon side effect of guanfacine and is probably due to drug-induced hypotension or bradycardia. © 2005 Movement Disorder Society [source] All is Not Lost: Utilizing Continuous Remote ILR Monitoring to Diagnose SyncopePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2010PAUL S. G. HONG M.D. A 63-year-old man with frequent unexplained syncope was implanted with a second generation remotely monitored implantable loop recorder for continuous electrocardiogram (ECG) monitoring. He had a subsequent syncopal episode and despite accidental destruction of his patient activator, vital ECG data from the event were transmitted wirelessly, enabling a cardiac arrhythmia to be excluded. This case highlights the benefit of remote monitoring in syncope assessment, as well as a transmission system that ensures prompt analysis of the ECG data and therefore rapid optimal patient management. (PACE 2010; 33:763,765) [source] Are Implantable Loop Recorders Useful in Detecting Arrhythmias in Children with Unexplained Syncope?PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2009KHALID N. AL DHAHRI M.B.B.S. Introduction: Syncope and presyncope are symptoms that occur infrequently in children, are unpredictable, and represent a diagnostic challenge to the physician. Conventional diagnostic investigations are often unable to establish a diagnosis, making it difficult to determine patient risk and direct appropriate therapy. The implantable loop recorder (ILR) is a medical device that was created for prolonged monitoring of heart rate and rhythm and has been used in a limited number of pediatric studies in which the cause of the syncope is unknown. Methods: This is a retrospective review of the clinical, surgical, and follow-up data of patients who had ILR devices implanted after conventional testing failed to identify a cause for their symptoms. Results: The diagnostic yield of the ILR device in unmasking the cause for symptoms in our patient cohort was 64%. In our study, manually activated events accounted for 71% of all documented episodes and 68% of the cases involving hemodynamically important arrhythmias or transient rhythm changes. The ILR device can be safely implanted and explanted in children without significant morbidity, in most cases. None of our patients experienced any long-term adverse events associated with placement of the device and all were alive at last follow-up. Conclusions: The use of the ILR device is a useful tool to help unmask arrhythmias as a cause of unexplained syncope in children. Patient selection for who should and should not have an ILR device implanted will continue to influence its diagnostic utility and generate controversy among stakeholders. [source] Nonischemic Dilated Cardiomyopathy: Results of Noninvasive and Invasive Evaluation in 310 Patients and Clinical Significance of Bundle Branch BlockPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2008BEATRICE BREMBILLA-PERROT M.D. Background:The survival of patients with idiopathic dilated cardiomyopathy (IDCM) at III and IV stages of New York Heart Association (NYHA) is decreased in those with a bundle branch block (BBB) compared to those without BBB. Less is known on the prognosis of patients at earlier stages of NYHA and who had a left BBB (LBBB) or right BBB (RBBB). We sought to evaluate the prevalence and the clinical significance of LBBB or RBBB in patients with IDCM and classes I and II of NYHA. Methods:Clinical data, noninvasive, and invasive studies were consecutively collected in 310 patients, with IDCM, followed up to 4.8±3.7 years. Results:Seventy-six patients (25%) had LBBB, 21 (7%) had RBBB, and 212 had no BBB. Patients with BBB were older than other patients (P < 0.009). Left ventricular ejection fraction (LVEF) was lower in LBBB than in RBBB and other patients (P < 0.05). Syncope was more frequent in BBB than in absence (P < 0.05). Incidence of spontaneous ventricular tachycardia (VT) and atrial fibrillation, VT induction, total cardiac events, and sudden death were similar in the presence or absence of BBB. Deaths by heart failure and heart transplantations tended to be more frequent in BBB than in absence. Conclusions:LBBB was present in 25% of patients with IDCM; RBBB was rare. Patients with BBB were older and had more frequent syncope than patients without BBB; LVEF was lower in LBBB than in RBBB or in absence of BBB. BBB did not increase the risk of spontaneous VT, VT induction, or sudden death, and tended to increase deaths by heart failure and the indications of heart transplantation. [source] Is Home Orthostatic Self-Training Effective in Preventing Neurally Mediated Syncope?PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2007Ph.D., YOUNG KEUN ON M.D. Background:Repeated orthostatic stress may prove to be of benefit in the regulation of neurally mediated syncope. But the role of home orthostatic self-training is not established to prevent symptoms in patients with neurally mediated syncope. We performed a prospective and randomized study to evaluate the effectiveness of repeated home orthostatic self-training in preventing tilt-induced neurally mediated syncope. Methods and Results:Fourty-two consecutive patients (24 males and 18 females, mean age 39 years, 16,68 years) with recurrent neurally mediated syncope were randomized into the tilt training and control groups. The home orthostatic self-training program consisted of daily sessions for 7 days a week for 4 weeks. In order to determine the effects of home orthostatic self-training, we repeated the head-up tilt test in both groups 4 weeks later. Among the tilt-training group, 9 of 16 patients (56%) had a positive response on follow-up head-up tilt test. Among the untreated control group, 9 of 17 patients (53%) had a positive response on follow-up head-up tilt test. In subgroup analyses according to the number of tilt-training sessions or the classified type, we found no differences in the follow-up head-up tilt test responses. Spontaneous syncope or presyncope over mean follow-up of 16.9 months were observed in 42.9% versus 47.1% in the tilt-training and control group, respectively. Conclusions:Home orthostatic self-training was ineffective in reducing the positive response rate of head-up tilt test in patients with recurrent neurally mediated syncope. [source] Myocardial Contractility and Cardiac Filling Measured by Impedance Cardiography in Patients with Nitroglycerine-Induced Vasovagal SyncopePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2006PETER MITRO Objective: Increased myocardial contractility and inadequate cardiac filling leading to activation of the Bezold-Jarisch reflex were proposed as possible triggering mechanisms of vasovagal syncope (VVS). In the present study noninvasive hemodynamic measurements were performed in order to examine the role of myocardial contractility and cardiac filling in pathogenesis of VVS. Methods: Hemodynamic parameters were measured during head-up tilt test (HUT) by impedance cardiography in 46 patients with unexplained syncope. Myocardial contractility was measured as index of contractility (IC), acceleration index (ACI), and ejection fraction (EF). Afterload was measured as systemic vascular resistance index (SVRI) and preload was expressed as end-diastolic index (EDI). Serial measurements were done 1 minute before HUT, during HUT at 1-minute intervals, and 1 minute after completion of HUT. Results: HUT was positive in 30 patients (10 men, 20 women, mean age 36 ± 16 years) and negative in 16 patients (8 men, 8 women, mean age 31 ± 14 years). No significant differences were observed between HUT(+) and HUT(,) groups in hemodynamic parameters at supine rest and during HUT until the development of syncope. SVRI was lower in HUT(+) than in HUT(,) group at syncope (122.7 + 66.3 vs 185.6 + 51.4 dyn sec cm,5/m2, P = 0.002) and after syncope (117.0 + 61.1 vs 198.0 + 95.7 dyn sec cm,5/m2, P = 0.007). ACI, IC, EF, and EDI did not differ between groups at syncope. After syncope EF was higher in HUT(+) group compared to HUT(,) group (59.2 + 6.1 vs 52.7 + 9.4%, P = 0.02). Conclusion: The role of increased myocardial contractility and decreased cardiac filling is not confirmed in the present study. [source] Significance of Inducible Ventricular Flutter-Fibrillation After Myocardial InfarctionPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2005BÉATRICE BREMBILLA-PERROT Aim: The purpose of this study was to determine the factors associated with the induction of ventricular flutter/fibrillation (VFl/VF)and its prognostic significance in post-myocardial infarction. Methods: Programmed ventricular stimulation was performed after myocardial infarction (MI) for syncope (n = 232) or systematically (n = 755); 230 patients had an induced VFl/VF and were followed during 4 ± 2 years. Results: VFl/VF was induced in 49/232 patients (21%) with syncope versus 181/755 asymptomatic patients (24%) (NS) and 94/410 patients (23%) with left ventricular ejection fraction (LVEF) <40% versus 136/577 patients (22.5%) with LVEF >40% (NS). Cardiac mortality was 9%; LVEF was 33 ± 15% in patients who died, 43 ± 13% in alive patients (P < 0.004). In patients with LVEF <40%, induced VFl/VF, mortality rate was 31% in those with syncope, 10% in asymptomatic patients (P < 0.001), because of an increase of deaths by heart failure; patients with LVEF >40% with or without syncope had a low mortality (5% and 3%). After linear logistic regression, VFl/VF and LVEF were predictors of total cardiac mortality, but only LVEF <40% predicted sudden death. Conclusion: Syncope and the level of LVEF did not increase the incidence of VFl/VF induction after MI, but modified the cardiac mortality: induced VF increased total cardiac mortality in patients with syncope and LVEF <40%, but did not increase sudden death. In patients with LVEF >40%, induced VFl/VF has no significance neither in asymptomatic patients nor in those with syncope. [source] Arrhythmic Storm Responsive to Quinidine in a Patient with Brugada Syndrome and Vasovagal SyncopePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2005MANLIO F. MÁRQUEZ A 37-year-old man with Brugada syndrome (BrS) and arrhythmic storm is described. One month after implantation of a cardioverter-defibrillator he presented with recurrent appropriate shocks for spontaneous ventricular fibrillation (VF). Because of this arrhythmic storm, quinidine therapy was initiated with total suppression of all spontaneous arrhythmias. He had remained free of arrhythmias for 22 months since quinidine initiation. Two episodes of VF occurred after the patient stopped taking the medication. The patient resumed quinidine and has been free of VF for the last 3 months. This response to quinidine in a patient with symptomatic BrS supports its role in the prophylaxis of arrhythmic events in BrS. [source] Abnormality of the Left Ventricular Sympathetic Nervous Function Assessed by I-123 Metaiodobenzylguanidine Imaging in Pediatric Patients with Neurocardiogenic SyncopePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2003RANA OLGUNTÜRK The purpose of this study was to assess the left ventricular sympathetic nervous system function in the patients with neurocardiogenic syncope (NCS) using I-123 metaiodobenzylguanidine (MIBG) imaging of the heart, and to compare the plasma noradrenaline (NA) and MIBG results of tilt positive and tilt negative patients following a head-up tilt test (HUT). The study included 30 patients. Their physical and laboratory examinations did not show a pathology that may be the cause of their syncope. HUT test was positive in 13 patients and negative in 17 patients. Plasma NA concentrations were higher in the HUT positive than the HUT negative group at the beginning and at the 10th minute of the test. Specific I-123 MIBG uptake assessed as the cardiac to mediastinal activity ratio in the delayed image was significantly higher in HUT positive group. The higher levels of MIBG uptake and plasma NA observed in HUT positive patients may reflect the greater capacity of NA storage in cardiac adrenergic neuronal tissue in patients with NCS. The results of this study support the critical role of autonomic nervous system in the pathophysiology of NCS and the excessive sympathetic nervous stimulation as the trigger of paradox reflex. (PACE 2003; 26:1926,1930) [source] Recurrent Syncope in a Patient After Myocardial InfarctionPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4p1 2003SUSANNE C. CREDNER CREDNER, S.C., et al.: Recurrent Syncope in a Patient After Myocardial Infarction. A patient with ischemic cardiomyopathy presented with burning pain of his body surface with consecutive orthostatic intolerance and recurrent syncopes. A diagnosis of acute autonomic dysfunction was made and the patient was treated with midodrine, resulting in restoration of orthostatic tolerance after 6 weeks of therapy. (PACE 2003; 26[Pt. I]:920,921) [source] Impairment of Coronary Microvascular Function in Patients with Neurally Mediated SyncopePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2p1 2003JAW-WEN CHEN CHEN, J.-W., et al.: Impairment of Coronary Microvascular Function in Patients with Neurally Mediated Syncope.Recent evidence suggests that myocardial ischemia may occur in patients with neurally mediated syncope and normal coronary angiograms. This study was conducted to evaluate if coronary microvascular function is impaired in such patients. Coronary hemodynamic studies and head-up tilt table tests (HUTs) were performed on 30 consecutive patients with normal coronary angiograms and recurrent syncope. Another ten subjects with atypical chest pain and no evidence of myocardial ischemia or syncope served as a control. Great cardiac vein flow (GCVF) and coronary sinus flow (CSF) were measured by the thermodilution method at baseline and after dipyridamole infusion (0.56 mg/kg IV for 4 minutes). Coronary flow reserve (CFR), derived from CSF and GCVF, was significantly lower in the 15 patients with positive HUT than in the other 15 patients with negative HUT (1.75 ± 0.48vs2.64 ± 0.8, P < 0.01and2.29 ± 0.45vs3.07 ± 0.63, P < 0.01, respectively). Ischemic-like ECG was noted during treadmill exercise test in 40% of the former and in 7% of the latter group(P = 0.01). There was no significant difference in CFR between patients with negative HUT and control subjects. Coronary microvascular function was impaired in syncopal patients with positive HUT and relatively preserved in those with negative HUT, suggesting the possible linkage between coronary microvascular dysfunction and the development of neurally mediated syncope. (PACE 2003; 26[Pt. I]:605,612) [source] Syncope and Polymorphic Ventricular TachycardiaPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2002BRUCE D. WALKER No abstract is available for this article. [source] 24-Hour Heart Rate Variability in Patients with Vasovagal SyncopePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2000CHIARA LAZZERI Since alterations in the autonomic nervous system are thought to play a major role in the pathogenesis of vasovagal syncope, we characterized the chronic autonomic profile of 44 patients with syncope and 20 healthy subjects by means of heart rate variability using 24-hour Holter recordings (time- and frequency-domain indexes), and evaluated whether the different types of responses to tilting (vasodepressive versus cardioinhibitory) could be associated with different cardiac autonomic patterns. Twenty-three patients exhibited a positive response to tilting, which was vasodepressive in 11 patients and cardioinhibitory in 12 patients. All vasodepressive patients had a standard deviation of the averages of NN (SDANN) intervals in all 5-minute segments lower than 100 ms. Patients with vasodepressive syncope also had significantly lower values of RMSSD (the 24-hour square root of the mean of the sum of the squares of differences between adjacent normal RR intervals) than those with cardioinhibitory response, and lacked the day-night rhythm of the low frequency/high frequency ratio. However, only SDANN values correctly identified patients with vasodepressive response to tilting. We conclude that (1) the population of patients with vasovagal syncope is heterogeneous, (2) patients with vasodepressive syncope have a peculiar chronic autonomic profile as assessed by 24-hour heart rate variability analysis, and (3) the evaluation of the autonomic profile in 24-hour Holter recordings could be of value in the diagnosis of patients with syncope. [source] Syncope and sinus bradycardia from combined use of thalidomide and , -blocker,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 10 2008Takashi Yamaguchi MD Abstract We present a case of a 76-year-old Japanese man with hypertension and multiple myeloma (MM) presented with syncope and sinus bradycardia. Thalidomide therapy for MM was added to longstanding atenolol therapy one month prior to presentation. His heart rate (HR) was around 70 beats per minute (bpm) before addition of Thalidomide. His HR on presentation was less than 30,bpm. He was treated with intravenous atropine followed by temporary pacemaker and taken off atenolol. His HR returned to around 70,bpm few days after discontinuation of atenolol, even though he was still taking thalidomide, permitting outpatient management without a pacemaker. Both thalidomide and atenolol have been reported to cause bradycardia. Neither agent caused bradycardia when used alone in this patient, but simultaneous use caused symptomatic bradycardia. As thalidomide is prescribed more frequently, clinicians should be aware of the possibility of drug-induced sinus bradycardia due to the interaction of thalidomide and , -blockers. Copyright © 2008 John Wiley & Sons, Ltd. [source] Correlation of Noninvasive Electrocardiography with Invasive Electrophysiology in Syncope of Unknown Origin: Implications from a Large Syncope DatabaseANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2009Konstantinos A. Gatzoulis Background: The evaluation of syncope can be expensive, unfocussed, and unrevealing yet, failure to diagnose an arrhythmic cause of syncope is a major problem. We investigate the utility of noninvasive electrocardiographic evaluation (12-lead ECG and 24-hour ambulatory electrocardiographic recordings) to predict electrophysiology study results in patients with undiagnosed syncope. Methods: We evaluated 421 patients with undiagnosed syncope who had an electrocardiogram (ECG), an electrophysiology study, and 24-hour ambulatory monitoring. Noninvasive testing was used to predict electrophysiology testing outcomes. Multivariable logistic regression analysis adjusting for age, sex, presence of heart disease, and left ventricular ejection fraction (LVEF) was used to assess independent predictors for sinus node disease, atrioventricular node disease, and induction of ventricular tachyarrhythmias. Results: Patients were divided into four groups: group 1, abnormal ECG and ambulatory monitor; group 2, abnormal ECG only; group 3, abnormal ambulatory monitor; and group 4, normal ECG and ambulatory monitor. The likelihood of finding at least one abnormality during electrophysiologic testing among the four groups was highest in group 1 (82.2%) and lower in groups 2 and 3 (68.1% and 33.7%, respectively). In group 4, any electrophysiology study abnormality was low (9.1%). Odds ratios (OR) were 35.9 (P < 0.001), 17.8 (P < 0.001), and 3.5 (P = 0.064) for abnormal findings on electrophysiology study, respectively (first three groups vs the fourth one). ECG and ambulatory monitor results predicted results of electrophysiology testing. Conclusion: Abnormal ECG findings on noninvasive testing are well correlated with potential brady- or/and tachyarrhythmic causes of syncope, in electrophysiology study of patients with undiagnosed syncope. [source] The Utility of Holter Monitoring Compared to Loop Recorders in the Evaluation of Syncope and PresyncopeANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2000Andrew D. Krahn M.D. Background: Holter monitoring is frequently used to assess patients with syncope, but rarely provides a diagnosis. Newer loop recorders provide the opportunity for prolonged electrocardiographic monitoring to enhance diagnostic yield. Methods: The results of 232 Holter monitors and 81 loop recordings performed for the investigation of syncope or presyncope were reviewed for indication, patient demographics, and presence and type of symptoms and/or arrhythmias. The results were classified as (1) symptom-arrhythmia correlation, (2) clinically useful information (group 1 plus those excluding arrhythmic syncope, and those demonstrating asymptomatic serious arrhythmias) and (3) unhelpful (asymptomatic and no serious arrhythmias). Results: Loop recorders provided a symptom-arrhythmia correlation in 11.1% of patients compared to only 0.4% in the Holter group (P < 0.0001). Clinically useful information was obtained in 54.3% of loop patients compared to 27.6% in the Holter group (P < 0.0001). Technical problems occurred in 0.4% of the Holter patients and in 3.7% of loop patients (P = 0.05). Classification was difficult in seven patients in the Holter group; two experienced symptoms during sinus rhythm but also had a serious asymptomatic arrhythmia, and five patients had 6,10 beats of asymptomatic ventricular tachycardia at a rate < 160 beats/min. Conclusion: Loop recording was well tolerated and superior to Holter monitoring in providing a symptom-arrhythmia correlation or clinically useful information in patients with syncope and presyncope. An initial approach with a loop-recording device should be employed in these patients. [source] | ||||||||||||||||||||||||||||||||||