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Hamdan MH, Brignole M, Michelet P, Deharo JC, Guieu R. The effect of capsaicin-phenylephrine-caffeine formulation on tilt-induced syncope in patients with a history of vasovagal syncope or near-syncope. Heart Rhythm 2025:S1547-5271(25)00086-4. [PMID: 39828073 DOI: 10.1016/j.hrthm.2025.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2025] [Revised: 01/04/2025] [Accepted: 01/14/2025] [Indexed: 01/22/2025]
Affiliation(s)
- Mohamed H Hamdan
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | - Michele Brignole
- Department of Cardiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Pierre Michelet
- Department of Anesthesia and Reanimation, Hôpital Conception, Marseille, France; Centre for Cardiovascular Research and Nutrition, C2VN, INSERM, INRAE, AMU, Marseille, France
| | - Jean Claude Deharo
- Centre for Cardiovascular Research and Nutrition, C2VN, INSERM, INRAE, AMU, Marseille, France; Department of Cardiology, Syncope Unit, Timone Hospital, Marseille, France
| | - Régis Guieu
- Centre for Cardiovascular Research and Nutrition, C2VN, INSERM, INRAE, AMU, Marseille, France; Laboratory of Biochemistry, AP-HM, Marseille, France
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Adenosine, Adenosine Receptors and Neurohumoral Syncope: From Molecular Basis to Personalized Treatment. Biomedicines 2022; 10:biomedicines10051127. [PMID: 35625864 PMCID: PMC9138351 DOI: 10.3390/biomedicines10051127] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
Adenosine is a ubiquitous nucleoside that is implicated in the occurrence of clinical manifestations of neuro-humoral syncope (NHS). NHS is characterized by a drop in blood pressure due to vasodepression together with cardio inhibition. These manifestations are often preceded by prodromes such as headaches, abdominal pain, feeling of discomfort or sweating. There is evidence that adenosine is implicated in NHS. Adenosine acts via four subtypes of receptors, named A1 (A1R), A2A (A2AR), A2B (A2BR) and A3 (A3R) receptors, with all subtypes belonging to G protein membrane receptors. The main effects of adenosine on the cardiovascular system occurs via the modulation of potassium ion channels (IK Ado, K ATP), voltage-gate calcium channels and via cAMP production inhibition (A1R and A3R) or, conversely, through the increased production of cAMP (A2A/BR) in target cells. However, it turns out that adenosine, via the activation of A1R, leads to bradycardia, sinus arrest or atrioventricular block, while the activation of A2AR leads to vasodilation; these same manifestations are found during episodes of syncope. The use of adenosine receptor antagonists, such as theophylline or caffeine, should be useful in the treatment of some forms of NHS. The aim of this review was to summarize the main data regarding the link between the adenosinergic system and NHS and the possible consequences on NHS treatment by means of adenosine receptor antagonists.
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