Comparison of recurrence rate based on the frequency of preceding symptoms in patients with neurocardiogenic syncope or presyncope

Atrial fibrillation occurring during head-up tilt testing: Once detected, atrial fibrillation should be monitored, regardless of how it is detected

BACKGROUND

Atrial fibrillation (AF) often progresses to more sustained forms and increases the risk of ischemic stroke or sinus node dysfunction. However, there have been no data on the clinical outcomes of patients who developed AF during head-up tilt testing (HUT).

OBJECTIVE

The purpose of this study was to evaluate the clinical significance of AF detected during HUT performed for syncope evaluation.

METHODS

We analyzed incidence, short- and long-term prognosis, and predictors of adverse outcomes of AF detected during HUT, which was performed in 6780 consecutive patients without AF history.

RESULTS

Of the 6780 patients, 52 (0.8%) developed AF during passive tilting (n = 5), isoproterenol infusion (n = 32), and recovery phase (n = 15) of HUT, respectively. There was no short-term adverse event: spontaneous sinus conversion occurred in 43 patients (83%) within 48 hours. Over a median follow-up of 34.8 months, 24 patients (46%) had AF recurrence with initial presentation as ischemic stroke (n = 2), sinus node dysfunction requiring pacemaker (n = 10), and AF alone (n = 12). In addition, 19 of 24 recurred AF cases (79.2%) progressed to persistent/permanent forms. The index AF duration was identified as an independent predictor of AF recurrence. Patients with longer AF duration (≥1.0 hour) showed worse prognosis than did those with shorter AF duration (<1.0 hour).

CONCLUSION

The incidence of AF during HUT was ∼0.8%, and short-term prognosis was favorable. However, about half of the cases were complicated by long-term adverse outcomes. Therefore, regular follow-up might be warranted for patients with HUT-induced AF, particularly when AF duration is long.

Renal nerve stimulation for treatment of neurocardiogenic syncope: a review from perspective of commercialization potential

A strong evidence of outcomes for vasovagal syncope is not easily identified. It would seem reasonable that the proposed Mayo Clinic technology would be reserved for cases with severe recurrent or refractory syncope. However, recurrence levels are relatively low, and while some predictive methods have been proposed, recurrence is also influenced by the interaction that occurs during screening and examinations, i.e. recurrence diminishes once an initial diagnosis has been made. Finally, a key factor in being able to identify suitable patients relates to understanding the relative significance of the vasodepression and cardioinhibitory components-the therapy is best suited to patients that have a significant level of both components. It is probably not needed in patients with mainly cardioinhibitory involvement-data from ISSUE 2 and ISSUE 3 studies suggest that this is a relatively large proportion, particularly with asystolic involvement. The challenge remains in having suitable screening tests to identify the best patients. Tilt table testing has questions concerning its ability to replicate clinical syncope-implantable loop recorders (ILRs) may provide more accurate data but their usage is not yet widely accepted given the costs and invasive nature of the monitor.

The effect of late adoption of Canadian innovations: a case for implantable cardiac monitors

Syncope is a sudden and generally momentary loss of consciousness, which can have serious adverse events. The outcomes of the syncope episode can vary from a fall to fatal accidents. Syncope has a major negative effect on the patient's health-related quality of life. The economic burden of syncope on healthcare systems is considerable. There are no clear diagnostic pathways for identifying the cause of syncope; patients can be admitted to hospital and undergo expensive and often repeated and inconclusive diagnostic tests. Implantable cardiac monitors have been available for more than a decade to help early diagnosis of syncope in unexplained cases. However, despite being a Canadian invention, the use of the implantable cardiac monitors has been suboptimal in the Canadian healthcare system. This study provides an overview of syncope, its management, and presents the estimated potential cost savings per diagnosis of systematic use of implantable cardiac monitors in Ontario.