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Effectiveness of cardioneuroablation in different subtypes of vasovagal syncope

Journal of Geriatric Cardiology 2024年第6期21卷 651-657页

作者： Bin TU Zi-Hao LAI Ai-Yue CHEN Zhi-Yuan WENG Si-Min CAI Zhu-Xin ZHANG Li-Kun ZHOU Li-Hui ZHENG Yan YAO Arrhythmia Center Fuwai HospitalNational Center for Cardiovascular DiseasesNational Key LaboratoryChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Cardiac Center Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina Cardiovascular Department The First Affiliated HospitalFujian Medical UniversityFujian Institute of HypertensionFujianChina Department of Cardiovascular The Second Affiliated Hospital of Zhejiang University School of MedicineZhejiangChina

BACKGROUND Cardioneuroablation(CNA)has shown encouraging results in patients with vasovagal syncope(VVS).However,data on different subtypes was scarce.METHODS This observational study retrospectively enrolled 141 patients[mean age:40±18 years,51 males(36.2%)]with the diagnosis of VVS.The characteristics among different types of VVS and the outcomes after CNA were analyzed.RESULTS After a mean follow-up of 4.3±1.5 years,41 patients(29.1%)experienced syncope/pre-syncope events after CNA.syncope/pre-syncope recurrence significantly differed in each subtype(P=0.04).The cardioinhibitory type of VVS had the lowest recurrence rate after the procedure(n=6,16.7%),followed by mixed(n=26,30.6%)and vasodepressive(n=9,45.0%).Additionally,a significant difference was observed in the analyses of the Kaplan-Meier survival curve(P=0.02).syncope/pre-syncope burden was significantly reduced after CNA in the vasodepressive type(Psyncope/pre-syncope after CNA have a lower baseline deceleration capacity(DC)level than those without(7.4±1.0 ms vs.9.0±1.6 ms,P=0.01).Patients with DCsyncope/pre-syncope recurrence after CNA compared to patients with DC≥8.4 ms,and this association still existed after adjusting for age and sex(HR=8.1,95%CI:2.2-30.1,P=0.02).CONCLUSIONS Different subtypes exhibit different event-free rates.The vasodepressive type exhibited the lowest event-free rate,but those patients with DC≥8.4 ms might benefit from CNA.

关键词： syncope subtypes diagnosis

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A Case Report of Recurrent Guillain-Barré Syndrome with Orthostatic Hypotension syncope as the First Symptom

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Proceedings of Anticancer Research 2024年第3期8卷 74-79页

作者： Shuai Yan Xin Liu Luxuan Wang Affiliated Hospital of Hebei University Baoding 071000Hebei ProvinceChina

Guillain⁃Barré syndrome (GBS) is an immune-mediated peripheral neuropathy with acute or subacute onset of flaccid paralysis of the limbs with symmetrical hypesthesia and autonomic nerve involvement [1]. The clinical manifestations of autonomic nerve damage are complex and varied, which may involve extensive or limited autonomic function damage, including abnormalities of the skin, pupil, urinary tract, gastrointestinal tract, cardiovascular system, body temperature, lacrimal and salivary glands, and sexual function, etc. [2], and some patients may even have autonomic nerve damage as the only symptom, which is a variant of GBS and is prone to misdiagnosis or underdiagnosis. Recurrence of GBS is rare, and the manifestations of recurrence are often similar to those of the first symptoms [3], but the patient admitted to our hospital had syncope as the main clinical manifestation of recurrence, which was completely different from that of the first incidence, and syncope is not a common and typical clinical manifestation of GBS, so misdiagnosis is highly likely.

关键词： Orthostatic hypotension syncope Guillain-Barrésyndrome

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Risk of pacemaker implantation after femur fracture in patients with and without a history syncope: a Danish nationwide registry-based follow-up study

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Journal of Geriatric Cardiology 2022年第9期19卷 712-718页

作者： Sara LK Clemmensen Kristian Kragholm Bhupendar Tayal Christian Torp-Pedersen Søren Kold Peter Søgaard Sam Riahi Department of Cardiology Aalborg University HospitalAalborgDenmark Unit of Clinical Biostatistics and Epi-demiology Aalborg University HospitalAalborgDenmark Department of Clinical Epidemiology Aalborg University HospitalAalborgDenmark Department of Orthopedics Aalborg University HospitalAalborgDenmark Depart-ment of Clinical Institute Aalborg University HospitalAalborgDenmark

BACKGROUND It has previously been described that fall-associated injuries including fractures are commonly observed among patients with bradyarrhythmia.However,knowledge on the risk of pacemaker implantation after admission due to femur fracture from large population-based epidemiologic data is lacking.Therefore,we investigated the risk of pacemaker implanta-tion following femur fracture in patients with and without a history of previous syncope.METHODS All patients with femur fracture between 2005-2017 were identified using the Danish Nationwide Patient Registry.Among these,patients already having a pacemaker were excluded.Primary outcome was one-year risk of pacemaker implanta-tion and secondary outcome was one-year all-cause mortality.Multivariable logistic regression was used to obtain absolute and relative risks of the study endpoint in relation to patients with versus without history of syncope and standardized to the age,sex,selected comorbidity and pharmacotherapy distribution of all patients.RESULTS Of 93,093 patients with femur fracture,5508(5.9%)had a history of syncope within five years.Patients with prior syn-cope were slightly older(84 vs.83 years),more often male(33.6%vs.29.4%),and had more often comorbidities relative to those without history of syncope.All-cause mortality was significantly higher among those with previous history of syncope com-pared to those without previous syncope(29.9%vs.28.6%,P=0.021).The relative mortality risk was 1.05(95%CI:1.01−1.09,P=0.021).A total of 695(0.8%)patients underwent pacemaker implantation within 5 years following femur fracture,and a signific-antly higher proportion of patients with syncope had a pacemaker implanted within one year(1.6%vs.0.7%,Psyncope was significantly associated with a higher one-year risk of pacemaker implantation.

关键词： patients syncope injuries

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Impact of comorbidities on the prognosis of pediatric vasovagal syncope

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World Journal of Pediatrics 2022年第9期18卷 624-628页

作者： Ya-Ru Wang Xue-Ying Li Jun-Bao Du Yan Sun Wen-Rui Xu Yu-Li Wang Ying Liao Hong-Fang Jin Department of Pediatrics Peking University First HospitalNo.1 Xi’an-men StreetWest DistrictBeijing100034China Department of Medical Statistics Peking University First HospitalBeijingChina Key Laboratory of Molecular Cardiovascular Sciences Ministry of EducationBeijingChina

Vasovagal syncope(VVS)is the primary entity of neurally mediated syncope(NMS)in childhood,and its prognosis is usually considered benign.However,it is found in clini-cal practice that some children with VVS appear to have a frequent recurrence of syncope and poor response to treat-ment[1],which might seriously affect their quality of life[2].In recent years,an increasing number of comorbidities of VVS have been reported.Liao et al.found that 31%of pediatric patients with NMS suffered from allergic disease[3],and Vallejo M reported that more than 50%of patients had headaches[4].These comorbidities might make the clinical manifestations even more complex.However,until now,it has been unclear whether comorbidities are associated with the prognosis of children and adolescents suffering from VVS.Therefore,the present study was conducted to examine whether there is any impact of comorbidities on the prognosis of pediatric VVS to better understand the outcome and management of children and adolescents with VVS.

关键词： syncope morbid pediatric

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Pacemaker electrode rupture causes recurrent syncope:A case report

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World Journal of Clinical Cases 2022年第33期10卷 12352-12357页

作者： Xiao-Yong Zhu Xin-Hu Tang Wen-Yin Huang Department of Cardiology Jiujiang University Affiliated HospitalJiujiang 332000Jiangxi ProvinceChina

BACKGROUND Currently,the implantation of permanent cardiac pacemakers entails mostly subclavian vein puncture,which is relatively simpler and easier to master.However,due to individual differences,some patients carry a narrow space between the clavicle and the first rib.If the range of activity of the upper limb is increased,the friction between the electrode wire and the bone gap leads to the breakage of the electrode wire,which is manifested by poor pacemaker perception and pacing.CASE SUMMARY A 68-year-old woman underwent permanent pacemaker implantation in our hospital because of third-degree atrioventricular block 6 years ago.At that time,the patient was recommended to have a dual-chamber permanent pacemaker implantation,and finally chose a single-chamber permanent pacemaker because she could not afford the cost.The patient has repeatedly lost consciousness for no obvious reason in the past 3 d,and went to our hospital for treatment.The chest X-ray showed that the pacemaker electrode was broken.After the patient was given a pacemaker electrode replacement,the patient did not continue to lose consciousness.CONCLUSION Because the electrodes implanted in the subclavian approach are close to the clavicle and the first rib,the pacemaker electrodes may wear out.If the patient loses consciousness again after the pacemaker is implanted,we should consider whether there is a pacemaker.The possibility of electrode breakage,and timely help the patient to replace the new pacemaker electrodes.

关键词： syncope Pacemaker Lead fracture Subclavian crush Case report

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Baroreflex sensitivity and its implication in neurally mediated syncope inchildren

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World Journal of Pediatrics 2023年第11期19卷 1023-1029页

作者： Ya-Xi Cui Jun-Bao Du Hong-Fang Jin Department of Pediatrics Peking University First HospitalBeijing 100034China Key Laboratory of Molecular Cardiovascular Sciences Ministryof EducationBeijing 100191China

Neurally mediated syncope(NMS)refers to an entity of syncopal disorders that can be triggered by a psychological stimulus,standing for a long time,sudden position change from supine to upright,or a muggy environment.Vasovagal syncope(VVS),also known as acute orthostatic intolerance(OI),is the main form of NMS[1]and seriously affects the quality of life of children.However,the pathogenesis of NMS has not yet been fully clarified.The mechanisms underlying NMS are considered to involve autonomic regulation abnormalities.

关键词： syncope acute pathogenesis

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Can pediatric vasovagal syncope be individually managed?

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World Journal of Pediatrics 2022年第1期18卷 4-6页

作者： Wen-Rui Xu Jun-Bao Du Hong-Fang Jin Department of Pediatrics Peking University First HospitalNo.1Xi’an-Men StreetWest DistrictBeijing 100034China Key Lab of Molecular Cardiovascular Sciences Ministry of EducationBeijingChina

In children and adolescents,syncope is common and accounts for a considerable proportion of emergency visits.The underlying diseases of pediatric syncope mainly include neurally mediated syncope(NMS)and cardiogenic conditions.NMS accounts for 70–80%of pediatric syncopal cases,and one of the most common forms is vasovagal syncope(VVS)[1–3].In children with VVS,owing to the impairment of the barorefex integrity,the sympathetic system usually becomes overexcited after the change in position,leading to forceful contractions of a relatively empty ventricle and fnally causing a sympathetic withdrawal and an increased vagal activity.A relatively insufcient central volume,excessive vasodilation of peripheral vessel,autonomic nervous dysfunction,and neurohormonal disturbance may be aggravating factors.However,the efectiveness of previously unselected treatments for VVS has not been satisfactory.As such,a comprehensive assessment of the clinical characteristics,pathogenesis,and biochemical markers is needed to select the corresponding therapy.Since individualized treatment for VVS was proposed,several improvements have been made in the feld.

关键词： syncope pediatric treatment

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Improving the approach to non-cardiac syncope in the emergency department observation unit

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World Journal of Emergency Medicine 2023年第2期14卷 128-132页

作者： Filippo Numeroso Ivo Casagranda Emergency Department University Hospital of ParmaParma 43126Italy Academy of Emergency Medicine and Care(AcEMC) Pavia 27100Italy

syncope is a rather frequent condition,responsible for1.0%–1.5%of emergency department (ED) visits.[1]Even if the development of clinical guidelines has improved the ED management of syncope,[2]the hospitalization rate is still very high (up to 50%),especially compared with the incidence of short-term adverse events,which is11%globally,but decreases to less than 4%when events already diagnosed in the ED are excluded,[1]meaning that most patients will not benefit from admission.

关键词： globally department syncope

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Arrhythmic syncope: From diagnosis to management

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World Journal of Cardiology 2023年第4期15卷 119-141页

作者： Jaume Francisco Pascual Pablo Jordan Marchite Jesús Rodríguez Silva Nuria Rivas Gándara Unitat d’Arritmies Servei de Cardiologia VHIR Hospital Universitari Vall d’HebronBarcelona 08035Spain Grup de Recerca Cardiovascular Vall d’Hebron Institut de RecercaBarcelona 08035Spain CIBER de Enfermedades Cardiovasculares Instituto de Salud Carlos ⅢMadrid 28029Spain Departament de Medicina Universitat Autònoma de BarcelonaBellaterra 08193Spain

syncope is a concerning symptom that affects a large proportion of patients.It can be related to a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death.However,benign causes are the most frequent,and identifying high-risk patients with potentially severe etiologies is crucial to establish an accurate diagnosis,initiate effective therapy,and alter the prognosis.The term cardiac syncope refers to those episodes where the cause of the cerebral hypoperfusion is directly related to a cardiac disorder,while arrhythmic syncope is cardiac syncope specifically due to rhythm disorders.Indeed,arrhythmias are the most common cause of cardiac syncope.Both bradyarrhythmia and tachyarrhythmia can cause a sudden decrease in cardiac output and produce syncope.In this review,we summarized the main guidelines in the management of patients with syncope of presumed arrhythmic origin.Therefore,we presented a thorough approach to syncope work-up through different tests depending on the clinical characteristics of the patients,risk stratification,and the management of syncope in different scenarios such as structural heart disease and channelopathies.

关键词： syncope Arrhythmia Electrophysiological study Loop recorder Myocardiopathy Atrioventricular conduction block

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Cases Report of Atypical Aortic Dissection

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Journal of Biosciences and Medicines 2024年第2期12卷 131-137页

作者： Yuan Tang Yong Hu Department of Neurology Xiangzhou District People’s Hospital Xiangyang China Emergency Department The First Affiliated Hospital of Guangxi University of Chinese Medicine Guangxi China

Background: Aortic dissection (AD) is one of the common causes of fatal chest pain in emergency medicine. The main and most common clinical manifestation is pain, with about 90% of patients experiencing sudden persistent, tearing or cutting-like pain in the chest or back. However, there have also been reports of myocardial infarction, heart failure, renal failure, syncope, shock, stroke, paraplegia and other cases. Clinical misdiagnosis is common. Aim: Alert clinicians to aortic dissection with shock and chest tightness as the main clinical presentations. Case Presentation: Report on two cases of aortic dissection with syncope and shock as the main manifestations. Conclusion: Aortic dissection is a highly dangerous cardiovascular emergency with a high mortality rate. In clinical practice, awareness of the clinical manifestations of aortic dissection should be increased. Careful inquiry about medical history, attention to atypical clinical presentations of aortic dissection, thorough physical examination, and comprehensive diagnostic evaluation can improve the success rate of diagnosing aortic dissection.

关键词： Aortic Dissection syncope Shock Chest Distress

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