Asystole on loop recorder in patients with unexplained syncope and negative tilt testing: age distribution and clinical predictors

Clinical Autonomic Research - Tập 34 Số 1 - Trang 137-142 - 2024
Vincenzo Russo1, Angelo Comune1, Erika B. Parente1, Anna Rago1, Andrea Antonio Papa1, Gerardo Nigro1, Michele Brignole2
1Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
2Faint & Fall Research Centre, Department of Cardiology, IRCCS Istituto Auxologico Italiano, S. Luca Hospital, Milan, Italy

Tóm tắt

Abstract Background Approximately 50% of patients with unexplained syncope and negative head-up tilt test (HUTT) who have an electrocardiogram (ECG) documentation of spontaneous syncope during implantable loop recorder (ILR) show an asystolic pause at the time of the event. Objective The aim of the study was to evaluate the age distribution and clinical predictors of asystolic syncope detected by ILR in patients with unexplained syncope and negative HUTT. Methods This research employed a retrospective, single-center study of consecutive patients. The ILR-documented spontaneous syncope was classified according to the International Study on Syncope of Uncertain Etiology (ISSUE) classification. Results Among 113 patients (54.0 ± 19.6 years; 46% male), 49 had an ECG-documented recurrence of syncope during the observation period and 28 of these later (24.8%, corresponding to 57.1% of the patients with a diagnostic event) had a diagnosis of asystolic syncope at ILR: type 1A was present in 24 (85.7%), type 1B in 1 (3.6%), and type 1C in 3 (10.7%) patients. The age distribution of asystolic syncope was bimodal, with a peak at age < 19 years and a second peak at the age of 60–79 years. At Cox multivariable analysis, syncope without prodromes (OR 3.7; p = 0.0008) and use of beta blockers (OR 3.2; p = 0.002) were independently associated to ILR-detected asystole. Conclusions In patients with unexplained syncope and negative HUTT, the age distribution of asystolic syncope detected by ILR is bimodal, suggesting a different mechanism responsible for asystole in both younger and older patients. The absence of prodromes and the use of beta blockers are independent predictors of ILR-detected asystole.

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Tài liệu tham khảo

Sutton R, Fedorowski A, Olshansky B et al. (2021) Tilt testing remains a valuable asset. Eur Heart J 42(17):1654–1660

Russo V, Parente E, Comune A et al. (2023) The clinical presentation of syncope influences the head-up tilt test responses. Eur J Intern Med 110:41–47

Brignole M, Moya A, de Lange FJ, ESC Scientific Document Group et al. (2018) 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 39(21):1883–1948 (PMID: 29562304)

Solbiati M, Casazza G, Dipaola F et al. (2017) The diagnostic yield of implantable loop recorders in unexplained syncope: a systematic review and meta-analysis. Int J Cardiol 15(231):170–176. https://doi.org/10.1016/j.ijcard.2016.12.128. (Epub 2016 Dec 22 PMID: 28052814)

Moya A, Brignole M, Menozzi C et al. (2001) International Study on Syncope of Uncertain Etiology (ISSUE) Investigators Mechanism of syncope in patients with isolated syncope and in patients with tilt-positive syncope. Circulation 104(11):1261–1267

Brignole M, Sutton R, Menozzi C et al. (2006) International Study on Syncope of Uncertain Etiology 2 (ISSUE 2) Group. Lack of correlation between the responses to tilt testing and adenosine triphosphate test and the mechanism of spontaneous neurally mediated syncope. Eur Heart J 27(18):2232–2239

Russo V, Parente E, Rago A et al. (2022) Cardioinhibitory syncope with asystole during nitroglycerin potentiated head up tilt test: prevalence and clinical predictors. Clin Auton Res 32(3):167–173

Torabi P, Rivasi G, Hamrefors V et al. (2022) Early and late-onset syncope: insight into mechanisms. Eur Heart J 43(22):2116–2123

Alboni P, Brignole M, Degli Uberti EC (2007) Is vasovagal syncope a disease? Europace 9(2):83–87

Alboni P, Alboni M (2017) Typical vasovagal syncope as a “defense mechanism” for the heart by contrasting sympathetic overactivity. Clin Auton Res 27(4):253–261

Brignole M, Rivasi G, Sutton R et al. (2021) Low-blood pressure phenotype underpins the tendency to reflex syncope. J Hypertens 39:1319–1325

Solari D, Tesi F, Unterhuber M et al. (2017) Stop vasodepressor drugs in reflex syncope: a randomised controlled trial. Heart 103(6):449–455

O’Dwyer C, Bennett K, Langan Y, Fan CW, Kenny RA (2011) Amnesia for loss of consciousness is common in vasovagal syncope. Europace 13(7):1040–1045

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Clinical Autonomic Research

Tập 34 Số 1

137-142

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