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Resumo Fundamento A síncope, na população pediátrica, tem como sua principal causa, a vasovagal (SVV). Sua avaliação deve ser feita por métodos clínicos e o teste de inclinação (TI) pode contribuir para seu diagnóstico. Objetivos Analisar o perfil clínico, os escores de Calgary e de Calgary modificado, a resposta ao TI e a variabilidade da frequência cardíaca (VFC) de pacientes ≤ 18 anos de idade, com presumida SVV. Comparar as variáveis entre pacientes com resposta positiva e negativa ao TI. Método Estudo observacional e prospectivo, com 73 pacientes com idades entre 6 e 18 anos, submetidos à avaliação clínica e ao cálculo dos escores, sem o conhecimento do TI. Este foi feito a 70º sob monitoramento para análise da VFC. Valor-p < 0,05 foi considerado como o critério de significância estatística. Resultados A mediana de idade foi de 14,0 anos, sendo que 52% eram no sexo feminino, 72 apresentaram Calgary ≥ -2 (média 1,80) e 69 com Calgary modificado ≥ -3 (média 1,38). Ocorreram pródromos em 59 pacientes, recorrência em 50 e trauma em 19. A resposta ao TI foi positiva em 54 (49 vasovagal, com 39 vasodepressora), com aumento do componente de baixa frequência (BF) e diminuição da alta frequência (AF) (p < 0,0001). Na posição supina, o BF foi de 33,6 no sexo feminino e 47,4 em unidades normalizadas no sexo masculino (p = 0,02). Aplicando-se a curva de operação característica para TI positivo, não houve significância estatística para VFC e os escores. Conclusões A maioria das crianças e adolescentes com diagnóstico presumido de SVV apresentaram um cenário clínico típico, com escore de Calgary ≥ -2, e resposta vasodepressora predominante ao TI. Verificou-se uma maior ativação simpática na posição supina no sexo masculino. Os escores de Calgary e a ativação simpática não permitiram predizer a resposta ao TI.
Abstract Background In the pediatric population, syncope is mainly from vasovagal (VVS) origin. Its evaluation must be done by clinical methods, and the tilt test (TT) can contribute to the diagnosis. Objectives To analyze the clinical profile, Calgary and modified Calgary scores, response to TT and heart rate variability (HRV) of patients aged ≤ 18 years with presumed VVS. To compare the variables between patients with positive and negative responses to TT. Method Observational and prospective study, with 73 patients aged between 6 and 18 years, submitted to clinical evaluation and calculation of scores without previous knowledge of the TT. It was done at 70º under monitoring for HRV analysis. P-value < 0.05 was the statistical significance criterion. Results Median age was 14.0 years; 52% of participants were female, 72 had Calgary ≥ -2 (mean 1.80), and 69 had modified Calgary ≥ -3 (mean 1.38). Prodromes were observed in 59 patients, recurrence in 50 and trauma in 19. The response to TT was positive in 54 participants (49 vasovagal, with 39 vasodepressor responses), with an increase in the low frequency (LF) component and a decrease in the high frequency (HF) component (p < 0,0001). In the supine position, LF was 33.6 in females and 47.4 in normalized units for males (p = 0.02). When applying the operating characteristic curve for positive TT, there was no statistical significance for HRV and scores. Conclusion Most children and adolescents with a presumed diagnosis of VVS presented a typical clinical scenario, with a Calgary score ≥ -2, and a predominant vasodepressor response to TT. Greater sympathetic activation was observed in the supine position in males. Calgary scores and sympathetic activation did not predict the response to TT.
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Orthostatic intolerance is a syndrome characterized by a series of symptoms that occur when standing upright, resulting in the loss of ability to maintain an upright position.This condition can be further classified into orthostatic hypotension, postural orthostatic tachycardia syndrome, and vasovagal syncope.Some scholars suggest that orthostatic hypertension may also be considered a part of this syndrome.The most significant risk associated with orthostatic intolerance is falls, which can lead to physical injury and psychological distress.This article aims to review the advancements made in the diagnosis and treatment of orthostatic intolerance, so as to enhance the standardization of clinical diagnosis and improve the effectiveness of treatment.
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Objective@#To analyze the related factors of the onset of vasovagal syncope (VVS) in children, and to provide basis for the early prevention, early diagnosis and early treatment of VVS.@*Methods@#A total of 126 children with syncope admitted to Department of Pediatric Cardiology, Second Hospital of Lanzhou University from October 2018 to September 2019 were invited in the study. Totally 73 cases of children diagnosed with VVS by HUTT were selected as VVS group, and 53 HUTT negative children were selected as control group. Related factors were retrospectively investigated, and risk factors for VVS were analyzed by univariate and multivariate regression.@*Results@#The VVS group showed statistically significant difference in age distribution with the control group ( χ 2=19.22, P <0.05). The VVS group showed statistically significant differences of proportion in family history, syncope history, prolonged standing, electrocardiogram abnormalities, and vitamin D deficiency (43.84%，31.51%，47.95%，34.25%， 30.14 %) compared with the control group (15.09%，13.21%，20.75%，15.09%，9.43%) ( χ 2=11.71,5.67,9.79,5.83,7.82, P < 0.05 ). Multivariate Logistic regression analysis showed that age and family historywere risk factors for VVS( χ 2=3.13, 11.06, P < 0.05 ).@*Conclusion@#Age and family history may be risk factors for the onset of VVS. Active attention should be paid to the high risk factors of child patient, early identification and diagnosis can prevent the occurrence and development of VVS in children.
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Objective@#To observe the effect of different doses of Shenfu injection on prognosis and quality of life for patients with vasovagal syncope (VVS).@*Methods@#A total of 126 patients were randomly divided into 3 groups. The control group (n=38) were treated by western medicine comprehensive therapy with tilting training. The low and high dose Shenfu injection groups were treated by Shenfu injection 40 ml/d (n=44) and 120 ml/d (n=44) on the treatment basis of control group. All the groups were treated for 14 days. The patients were followed up for 1 year after discharge. The relapse rate of syncope, quality of life social support rating scale (SSRS), effective rate of treatment, time of stable blood pressure, time of stable heart rate, recovery time of autonomic nervous disorder and adverse reactions were observed in each groups.@*Results@#The total effective rate was 47.4% (18/38) in the control group, 72.7% (32/44) in the low dose group, and 90.9% (40/44) in the high dose group. The difference between the three groups was statistically significant (χ2=18.997, P<0.01), and the total effective rate of Shenfu injection high-dose group was significantly higher than that of low-dose group (P<0.05). After treatment, there were significant differences in the recovery time of blood pressure, heart rate and autonomic nervous disorder among the three groups (F=19.165, 158.428, 33.405, P<0.01). The above indicators in the high dose group of Shenfu injection were significantly higher than the low dose group (t=-4.020, -5.180, -5.307, P<0.05). After 1 year of follow-up, the recurrence rate of the control group was 61.1% (11/18), the low-dose group was 18.8% (6/32), and the high-dose group was 5% (2/40), where there was significant difference among all the groups (χ2=20.886, P<0.01). The quality of life scores were compared for 1 year among the 3 groups, and the difference was statistically significant (F=23.025, P<0.01).@*Conclusions@#The Shenfu injection combined with Western medicine comprehensive therapy can improve the prognosis and quality of life of patients with VVS, and the improvement of each indicator of daily dosage of 120 ml is better than the daily dosage of 40 ml Shenfu injection.
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Objective To observe the effect of different doses of Shenfu injection on prognosis and quality of life for patients with vasovagal syncope (VVS). Methods A total of 126 patients were randomly divided into 3 groups. The control group (n=38) were treated by western medicine comprehensive therapy with tilting training. The low and high dose Shenfu injection groups were treated by Shenfu injection 40 ml/d (n=44) and 120 ml/d (n=44) on the treatment basis of control group. All the groups were treated for 14 days. The patients were followed up for 1 year after discharge. The relapse rate of syncope, quality of life social support rating scale (SSRS), effective rate of treatment, time of stable blood pressure, time of stable heart rate, recovery time of autonomic nervous disorder and adverse reactions were observed in each groups. Results The total effective rate was 47.4% (18/38) in the control group, 72.7% (32/44) in the low dose group, and 90.9% (40/44) in the high dose group. The difference between the three groups was statistically significant (χ2=18.997, P<0.01), and the total effective rate of Shenfu injection high-dose group was significantly higher than that of low-dose group (P<0.05). After treatment, there were significant differences in the recovery time of blood pressure, heart rate and autonomic nervous disorder among the three groups (F=19.165, 158.428, 33.405, P<0.01). The above indicators in the high dose group of Shenfu injection were significantly higher than the low dose group (t=-4.020, -5.180, -5.307, P<0.05). After 1 year of follow-up, the recurrence rate of the control group was 61.1% (11/18), the low-dose group was 18.8% (6/32), and the high-dose group was 5% (2/40), where there was significant difference among all the groups (χ2=20.886, P<0.01). The quality of life scores were compared for 1 year among the 3 groups, and the difference was statistically significant (F=23.025, P<0.01). Conclusions The Shenfu injection combined with Western medicine comprehensive therapy can improve the prognosis and quality of life of patients with VVS, and the improvement of each indicator of daily dosage of 120 ml is better than the daily dosage of 40 ml Shenfu injection.
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Abstract Background: Maintenance of orthostatism requires the interaction of autonomic and muscle responses for an efficient postural control, to minimize body motion and facilitate venous return in a common type of syncope called neurocardiogenic syncope (NCS). Muscle activity in standing position may be registered by surface electromyography, and body sway confirmed by displacement of the center of pressure (COP) on a force platform. These peripheral variables reflect the role of muscles in the maintenance of orthostatism during the active tilt test, which, compared with muscle activity during the passive test (head-up tilt test), enables the analyses of electromyographic activity of these muscles that may anticipate the clinical effects of CNS during these tests. Objective: to evaluate and compare the effects of a standardized protocol of active and passive tests for CNS diagnosis associated with the effects of Valsalva maneuver (VM). Methods: twenty-thee clinically stable female volunteers were recruited to undergo both tests. EMG electrodes were placed on muscles involved in postural maintenance. During the active test, subjects stood on a force platform. In addition to electromyography and the platform, heart rate was recorded during all tests. Three VMs were performed during the tests. Results: progressive peripheral changes were observed along both tests, more evidently during the active test. Conclusion: the active test detected changes in muscle and cardiovascular responses, which were exacerbated by the VM.
Resumo Fundamento: A manutenção do ortostatismo requer interação das respostas autonômicas e musculares para um controle postural eficiente e minimizar oscilações do corpo e facilitar o retorno venoso frente a um tipo comum de síncope chamada neurocardiogênica (SNC). A atividade da musculatura na posição de pé pode ser documentada por meio da eletromiografia de superfície (EMG) e as oscilações do corpo confirmadas pelo deslocamento do centro de pressão (CP) sobre uma plataforma de força. Estas variáveis periféricas mostram o papel muscular na manutenção do ortostatismo durante o tilt test ativo bem como esta atividade muscular ser comparada durante o teste passivo, Head-Up Tilt test, na tentativa de verificar alterações na atividade eletromiográfica destes músculos que podem antecipar os efeitos clínicos da SNC durante estes testes. Objetivo: Avaliar e comparar os efeitos de um protocolo padronizado para testes ativo e passivo de detecção da SNC associado ao efeito da manobra de valsalva (MV). Métodos: 23 voluntárias mulheres clinicamente saudáveis foram recrutadas para realizar ambos os testes. Os eletrodos da EMG foram posicionados em músculos associados com a manutenção postural, além de durante o teste ativo os sujeitos realizarem a postura ortostática sobre uma plataforma de força. Foi registrado além da EMG e da plataforma, a frequência cardíaca durante todo o teste. Três MV foram realizadas durante os testes. Resultados: Alterações periféricas foram verificadas de maneira progressiva ao longo dos testes, sendo mais evidente durante o teste ativo. Conclusão: o teste ativo verificou mudanças mais evidentes nas respostas musculares e cardiovasculares, amplificadas pela MV.
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Humans , Female , Adolescent , Adult , Young Adult , Tilt-Table Test/methods , Muscle, Skeletal/physiology , Heart Rate/physiology , Posture , ElectromyographyABSTRACT
Objective@#To analyze the distribution of the regulator of G protein signaling 2 (RGS2) gene C1114G polymorphism in children with vasovagal syncope (VVS) and the associated clinical classification groups, and to explore the association between RGS2 C1114G and VVS.@*Methods@#This was a prospective case-control study. A head-up tilt test (HUT) was performed in 300 children visiting Children's Hospital Affiliated to Shanghai Jiaotong University from August 2010 to December 2015 for unexplained syncope. A total of 150 children with positive HUT and a diagnosis of VVS were enrolled and assigned to the VVS group. The VVS group was further divided into 3 subgroups based on characteristics of the heart rate and blood pressure measured during the HUT. A total of 150 children with negative HUT were enrolled and assigned to the HUT-negative group. A total of 150 healthy children were enrolled as the normal control group for genetic polymorphism detection. The clinical characteristics of patients in the VVS group and the HUT-negative group were recorded. Peripheral blood samples of each case were collected. RGS2 C1114G polymorphism was evaluated using high-resolution melting curve and polymerase chain reaction together with gene sequencing. The genotype and allele frequency were analyzed and compared among different groups (VVS, HUT-negative, and normal control) and VVS subgroups. Comparisons among groups were performed using Chi-square test.@*Results@#Patients in the VVS group (48 males and 102 females, aged (10.1±3.2) years) were more frequently female (68.0% vs. 57.3%;χ2=5.090, P=0.024) compared with patients in the HUT-negative group (67 males and 83 females, aged (10.8±2.2) years). No significant difference was found regarding the distribution of the CC genotype, CG genotype and GG genotype among the VVS group (n=98, 65.3%; n=36, 24.0%; n=16, 10.7%), the HUT-negative group (n=112, 74.7%; n=28, 18.7%; n=10, 6.7%) and the normal control group (n=108, 72.0%; n=31, 20.7%; n=11, 7.3%) (χ2=3.632, P=0.458). There was no significant difference in the frequencies of C allele and G allele in the VVS group (n=232, 77.3%; n=68, 22.7%), the HUT-negative group (n=252, 84.0%; n=48,16.0%) and the normal control group (n=247, 82.3%; n=53, 17.7%) (χ2=4.659, P=0.097). The 150 children in the VVS group were further divided into the mixed-response subgroup (n=83), vasodepressor-response subgroup (n=42) and cardioinhibitory-response subgroup (n=25). The CC genotype, CG genotype and GG genotype in the mixed-response subgroup, the vasodepressor-response subgroup and the cardioinhibitory-response subgroup were (n=65, 78.3%; n=16, 19.3%; n=2, 2.4%), (n=20, 47.6%; n=11, 26.2%; n=11, 26.2%) and (n=13, 52.0%; n=9, 36.0%; n=3, 12.0%), respectively. The frequencies of C allele and G allele in the mixed-response subgroup, the vasodepressor-response subgroup, and the cardioinhibitory-response subgroup were (n=146, 88.0%; n=20, 12.0%), (n=51, 60.7%; n=33, 39.3%) and (n=35, 70.0%; n=15, 30.0%), respectively. The percentages of the GG genotype and G allele were significantly higher in the vasodepressor-response subgroup than the other two subgroups (χ2=21.698, 25.345, all P=0.000).@*Conclusions@#No significant association was found between RGS2 C1114G polymorphism and VVS in children. Due to the higher distribution of GG genotype and G allele in the vasopressor-response subgroup, RGS2 C1114G may be associated with the regulation of blood pressure during the onset of VVS in children.
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Objective:To explore the clinical characteristics of the co-morbidity of vasovagal syncope (VVS) and postural tachycardia syndrome (POTS) with allergic diseases in children.Methods:A retrospective analysis was launched to summarize the clinical data of children with VVS and POTS.They were divided into allergic group and non-allergic group according to the history of allergic diseases.The participants' clinical characteristics were compared between allergic group and non-allergic group using independent sample t test or rank sum test;composition comparisons were completed by Chi-square test.Bi-variate correlation analysis was used to explore the association between eosinophil percentage/count and symptom scores/frequency of syncope episodes.A P value ＜ 0.05 was defined as statistically significant.Results:Sixty-seven children complaining of orthostatic intolerance (43 patients diagnosed as VVS and 24 cases diagnosed as POTS) were enrolled.Totally 21 cases (31％) had allergic diseases,inclu ding allergic rhinitis,atopic eczema,asthma,as well as food allergy.And allergic rhinitis is the most common co-morbidity.There were no significant differences between the two groups in age,gender ratio,height,body weight and basement blood pressure.Compared with the non-allergic group,the allergic group showed later onset age (year) (11 ± 2 vs.9 ± 3,P ＜ 0.05) of orthostatic intolerance and shorter course of the diseases (month) [8.0 (0.1,0.1) vs.24.0 (0.1,144.0),P＜0.05].The frequency of syncope episodes in the allergic group among VVS children (times per month) [2.50 (0.08,30.00) vs.O.25 (0.03,5.00),P ＜ 0.05] was much higher than that in the non-allergic group.Additionally,the eosinophil percentage (％) [3.50 (0.70,0.59) vs.1.65 (0.30,6.20),P＜0.001] and eosino phil count (×109) [0.18 (0.05,0.71) vs.0.10 (0.02,0.38),P＜0.001] were increased in the allergic group.However,there were no remarkable differences in the results of head-up tilt test in children with VVS or in the maximum change of heart rate during standing test in children with POTS were involved.Conclusion:Allergic diseases are common co-morbidities in children with both VVS and POTS.Allergic rhinitis is the most common co-morbidity.Children with co-morbidity of VVS/POTS and allergic diseases had a later onset of symptoms of orthostatic intolerance,and were more likely to be hospitalized for intensive attacks of symptoms during a short period when compared with those without allergic diseases.Children diagnosed as VVS combined with allergic diseases had more frequent episodes of syncope.
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Objective@#To explore the relationship between venous blood routine test parameters and syncopal recurrence of children with vasovagal syncope (VVS).@*Method@#Sixty-three children (male 32, female 31) diagnosed as VVS in Department of Pediatrics, Peking University First Hospital from November 2010 to October 2015 were included in a case observational study.Their mean age was (11.2±2.7) years and basic treatment such as predisposing causes avoiding, standing training, autonomic nervous function exercise and oral rehydration salts were advised to them.The clinical data were obtained by out-patient visit and over telephone from December 2015 to January 2016, with a median follow-up period of 10 (4, 26) months. The effects of baseline venous blood routine test parameters, gender, age, and body mass index (BMI) on syncopal recurrence were studied via univariate and multivariate Cox regression analysis.Kaplan-Meier curve was used to evaluate the long-term prognosis.@*Result@#Among the 63 VVS children in this study, 31 cases were diagnosed as VVS vasodepressor type, 4 cases as VVS cardioinhibitory type and 28 cases as VVS mixed type, 16 cases (25%) had experienced recurrence of syncope while 47 cases (75%) had not.The result of univariate analysis of Cox regression showed that baseline platelet count (PLT) (HR=1.012, 95%CI: 1.003-1.022) had a marked impact on the survival rate.And the result of multivariate analysis of Cox regression showed that baseline hemoglobin concentration (HGB) (HR=1.055, 95%CI: 1.007-1.105), mean corpuscular hemoglobin (MCH) (HR=0.612, 95%CI: 0.423-0.884) and PLT(HR=1.015, 95%CI: 1.006-1.024) had significant effects on survival rate of VVS children.In this study, the one-year, two-year, and three-year survival rate were 83% (52/63), 79% (50/63) and 75% (47/63), respectively.@*Conclusion@#The baseline venous blood routine test parameters HGB, MCH and PLT might be the influencing factors of the syncopal recurrence of VVS children.
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Abstract Background: Cardioinhibitory vasovagal response is uncommon during the tilt test (TT). Heart rate variability (HRV) by use of spectral analysis can distinguish patients with that response. Objective: To compare the HRV in patients with cardioinhibitory vasovagal syncope (case group - G1) with that in patients without syncope and with negative response to TT (control group - G2). Methods: 64 patients were evaluated (mean age, 36.2 years; 35 men) and submitted to TT at 70 degrees, under digital Holter monitoring. The groups were paired for age and sex (G1, 40 patients; G2, 24). Results: In G1, 21 patients had a type 2A response and 19 had type 2B, with mean TT duration of 20.4 minutes. There was a greater low frequency (LF) component (11,6 versus 4,5 ms2, p=0.001) and a lower low/high frequency ratio in the supine position (3,9 versus 4,5 ms2, p=0.008) in G1, with no difference during TT between the groups. Applying the receiver operating characteristic curve for cardioinhibitory response, the area under the curve was 0.74 for the LF component in the supine position (p = 0.001). The following were observed for the cutoff point of 0.35 ms(2) for the LF component: sensitivity, 97.4%; specificity, 83.3%; positive predictive value, 85.3%; negative predictive value, 96.9%; and positive likelihood ratio, 5.8. Conclusion: HRV in the supine position allowed identifying patients with syncope and cardioinhibitory response with a high negative predictive value and likelihood ratio of 5.8.
Resumo Fundamento: A resposta cardioinibitória vasovagal ao teste de inclinação (TI) é pouco frequente. A variabilidade da frequência cardíaca (VFC) por meio da análise espectral pode discernir os pacientes (pts) com aquela resposta. Objetivo: Avaliar a VFC em pts com síncope vasovagal cardioinibitória (grupo caso - G1), comparando-a com a VFC de pts sem síncope e com resposta negativa ao TI (grupo controle - G2). Métodos: foram avaliados 64 pts, média de idade 36,2 anos, 35 homens, submetidos ao TI a 70º, sob monitoramento pelo Holter digital. Os grupos foram pareados por idade e sexo, sendo 40 pts do G1 e 24 do G2. Resultados: No G1, 21 pts apresentaram resposta tipo 2A e 19, tipo 2B, com média do TI de 20,4 min. Houve maior valor do componente de baixa frequência (BF) (11,6 versus 4,5 ms2, p=0,001) e menor relação baixa/alta frequência na posição supina (3,9 versus 4,5 ms2, p=0,008) no G1, sem diferença durante o TI. Aplicando-se a curva de operação característica para resposta cardioinibitória, foi obtida a área abaixo da curva de 0,74 para o componente BF na posição supina (p=0,001). Para o ponto de corte de 0,35 ms2 para BF observaram-se: sensibilidade, 97,4%; especificidade, 83,3%; valor preditivo positivo, 85,3%; valor preditivo negativo, 96,9%; e razão de probabilidade positiva, 5,8. Conclusão: A VFC na posição supina permitiu identificar os pts com síncope e com resposta cardioinibitória, com um alto valor preditivo negativo e uma razão de probabilidade de 5,8.
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Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Tilt-Table Test/methods , Syncope, Vasovagal/physiopathology , Heart Rate/physiology , Reference Values , Time Factors , Blood Pressure/physiology , Prospective Studies , ROC Curve , Electrocardiography, Ambulatory , Supine Position/physiology , Statistics, Nonparametric , Electrocardiography/methodsABSTRACT
Abstract Background: Most international studies on epidemiology of transient loss of consciousness (TLC) were performed many years ago. There are no data about the lifetime prevalence of TLC in Russia. Objective: To identify the lifetime prevalence and presumed mechanisms of TLC in an urban Russian population. Methods: 1796 individuals (540 males [30.1%] and 1256 females [69.9%]) aged 20 to 69 years (mean age 45.8 ± 11.9 years) were randomly selected and interviewed within the framework of multicentre randomised observational trial. Results: The overall prevalence of TLC in the studied population was 23.3% (418/1796), with the highest proportion (28%) seen in 40-49 year age group. TLC was significantly more common in women than in men (27.5% vs 13.5%). The mean age of patients at the time of the first event was 16 (11; 23) years, with 333 (85%) individuals experiencing the first episode of TLC under 30 years. The average time after the first episode of TLC was 27 (12; 47) years. The following mechanisms of TLC were determined using the questionnaire: neurally-mediated syncope (56.5%), arrhythmogenic onset of syncope (6.0%), nonsyncopal origin of TLC (1.4%), single episode during lifetime (2.1%). Reasons for TLC remained unidentified in 34% cases. 27 persons (6.5%) reported a family history of sudden death, mainly patients with presumably arrhythmogenic origin (24%). Conclusion: Our findings suggest that the overall prevalence of TLC in individuals aged 20-69 years is high. The most common cause of TLC is neurally-mediated syncope. These data about the epidemiology can help to develop cost-effective management approaches to TLC.
Resumo Fundamento: A maioria dos estudos internacionais sobre epidemiologia da perda de consciência temporária (PCT) foi realizada há muitos anos. Não há dados sobre sua prevalência ao longo da vida na Rússia. Objetivo: Identificar a prevalência ao longo da vida e os supostos mecanismos da PCT em uma população russa urbana. Métodos: 1.796 indivíduos (540 homens 30,1% e 1.256 mulheres 69,9%) com idade entre 20 e 69 anos (idade média, 45,8 ± 11,9 anos) foram selecionados aleatoriamente e entrevistados no contexto de um estudo multicêntrico randomizado observacional. Resultados: A prevalência global de PCT na população estudada foi 23,3% (418/1.796), sendo a mais alta proporção (28%) observada na faixa etária de 40-49 anos. PCT foi significativamente mais comum nas mulheres (27,5% vs 13,5%). A idade média dos pacientes por ocasião do primeiro evento foi 16 (11; 23) anos, com 333 (85%) indivíduos experienciando o primeiro episódio de PCT antes dos 30 anos. O tempo médio após o primeiro episódio de PCT foi 27 (12; 47) anos. Os seguintes mecanismos de PCT foram determinados usando-se um questionário: síncope neuromediada (56,5%), síncope de origem arritmogênica (6,0%), PCT de origem não sincopal (1,4%), episódio único durante a vida (2,1%). A causa de PCT não foi identificada em 34% dos casos, sendo que 27 pacientes (6,5%) relataram história familiar de morte súbita, principalmente aqueles com PCT de suposta origem arritmogênica (24%). Conclusão: Nossos achados sugerem uma alta prevalência global de PCT em indivíduos com idade entre 20 e 69 anos. A causa mais comum de PCT é a síncope neuromediada. Esse dado sobre a epidemiologia pode contribuir para o desenvolvimento de abordagem custo-efetiva para PCT.
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Humans , Male , Female , Adult , Middle Aged , Aged , Unconsciousness/etiology , Unconsciousness/epidemiology , Cardiovascular Diseases/complications , Arrhythmias, Cardiac/complications , Urban Population , Cardiovascular Diseases/genetics , Prevalence , Surveys and Questionnaires , Russia/epidemiology , Sex Distribution , Age Distribution , Syncope, Vasovagal/diagnosis , Genetic Predisposition to Disease , Death, Sudden/etiologyABSTRACT
Objective: To explore the safety and efficacy of left atrial (LA) endocardial vagal denervation catheter ablation for treating the patients with refractory vasovagal syncope (VVS). Methods: A total of 57 consecutive refractory VVS patients with severe symptom and positive response to head-up tilt test (HUT) were enrolled. There were 22 male at the mean age of (43 ± 13) years. The patients had no response or couldn’t tolerate routine treatment. LA model was re-established by three-dimensional mapping system, 10 patients received high-frequency stimulation technique for ganglionated plexi (GP) ablation and 47 received regional catheter ablation at 5 anatomic sites of GP for LA endocardial vagal denervation treatment. In-operative vagal response including hypotension, sinus bradycardia or asystole were observed, the endpoint of ablation was abolition of evoked vagal relfexes. Periodical follow-up was conducted to record the syncope recurrence and to re-examine ECG and HUT in all patients. Results: There were 52/57(91.2%) patients had positive vagal response by radiofrequency application and reached the endpoint of ablation; 4 patients couldn’t receive obvious evoked vagal relfexes. During (36 ± 22) months follow-up period, there were 52 (91.2%) cases without syncope recurrence, 11 cases still having palpitation, amaurosis and dizziness as the precursors of syncope while the symptoms were much better then they were before. No complication occurred. Conclusion: LA endocardial vagal denervation catheter ablation is a safe and effective method for treating the patients with refractory VVS, it may also effectively prevent VVS recurrence.
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Objective:To explore the value of social support rating scale using in patients with vasovagal syncope (VVS) .Methods:Social support rating scale (SSRS) established by XIAO Shui-yuan was used .A total of 200 VVS patients were collected from inpatients and outpatients and they received social support status investigation ,another 100 normal people were collected from our physical examination center were regarded as control (normal control group) .Results:Compared with normal control group ,there were significant reductions in scores of each item and total score of social support [ (37.22 ± 9.15) scores vs .(33.50 ± 8.64) scores] in VVS group ,P<0.05 or <0.01 ;compared with male patients ,there were significant rise in scores of subjective support [ (17.63 ± 6.72) scores vs . (18.62 ± 7.56) scores] ,utilization of support [ (7.51 ± 2.26) scores vs .(8.92 ± 2.82) scores] and total social sup-port [(34.32 ± 10.61) scores vs .(36.79 ± 7.86) scores] ,and significant reduction in objective support score [(9.28 ± 4.15) scores vs .(8.37 ± 3.49) scores] in female patients , P<0.05 or <0.01;compared with middle-aged and aged group ,there were significant rise in scores of subjective support [ (17.08 ± 6.34) scores vs .(19.51 ± 6.73) scores] and total social support [(33.18 ± 10.74) scores vs .(36.87 ± 8.73) scores] ,and significant reduction in uti-lization of support score [ (8.47 ± 2.60) scores vs .(7.53 ± 1.95) scores] in young group ,P<0.05 or <0.01. Con-clusion:Social support assessment is help to perform individualized diagnosis and therapy for patients with vasovagal syncope ,and help to improve their quality of life .
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Objective:To explore diagnostic value of basic head-up tilt table test (HUT)and sublingual nitroglycerin head-up tilt table test (SNHUT)on vasovagal syncope (VVS).Methods:A total of 61 patients,who collapsed be-cause of unknown causes and were highly suspected as VVS,were regarded as VVS group,received HUT,and an-other 22 healthy subjects were regarded as healthy control group.Results:Among the 61 cases of VVS group,57 ca-ses were tilt test positive and the positive rate was 93.44%.Among them,there were 16 cases (26.23%)with posi-tive basic HUT and 41 cases (67.21%)with positive SNHUT.The 22 cases in healthy control group also received basic HUT and SNHUT,one case (4.54%)was basic HUT positive and three cases were SNHUT positive.Positive rates of SNHUT was higher than that of HUT,but there was no significant difference in VVS group (χ2 =0.175,P =0.683).Conclusion:HUT is a noninvasive,repeatable method easily accepted by patients for diagnosing VVS currently.It can elevate positive rate of test when combined with SNHUT.
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Objective To summarize the risk factors of head up tilt test (HUTT) in children with vasovagal syncope,and provide theoretical reference for the diagnosis of vasovagal syncope.Methods The total of 340 children with headache and syncope were included in the study,all the cases received HUTT,including basic tilt table test and sublingual nitroglycerin test.And they were divided into HUTT positive group and HUTT negative group according to the results.The clinical information of two groups was analyzed by multivariate Logistic regression to summarize risk factors.Results The frequency of syncope in HUTT positive group was 2.3 ± 1.1,significantly higher than that in HUTT negative group (0.7 ±0.2),chest tightness and blurred vision ratios were significandy higher than those in HUTT negative group (84/186,48/186 vs.34/154,23/154).Single factor analysis showed,older than 12 years old,female,blurred vision,with history and genetic history of syncope,numerous of syncope,chest tightness,fatigue were related factors as positive results for HUTT.Multivariate Logistic regression analysis showed,older than 12 years old,female,with history and genetic history of syncope were independent risk factors of positive HUTF.β was 0.744,1.126,1.312,0.514 respectively,95％ CI was 1.132-5.968,1.985-5.040,1.366-9.677,1.683-6.532 respectively.Conclusion Age,gender,family history,history of syncope have important significance to predict HUTT results.
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Vasovagal syncope is one of the most common causes of transient syncope during anesthesia for elective surgery in patients with a history of syncope and requires special attention and management of anesthetics. The causes and pathophysiological mechanism of this condition are poorly understood, but it has a benign clinical course and recovers spontaneously. However, in some cases, this condition may cause cardiovascular collapse resulting in major ischemic organ injury and be life threatening. Herein we report a case and review literature, regarding completing anesthesia safely during an elective surgery of a 59-year-old female patient with history of loss of consciousness due to suspected vasovagal syncope followed by cardiovascular collapse and cardiac arrest, which required cardiopulmonary resuscitation and insertion of a temporary pacemaker and intra-aortic balloon pump immediately after a fine-needle aspiration biopsy of a lung nodule located in the right middle lobe.
Subject(s)
Female , Humans , Middle Aged , Adenocarcinoma , Anesthesia , Anesthetics , Biopsy, Fine-Needle , Cardiopulmonary Resuscitation , Heart Arrest , Lung Neoplasms , Lung , Syncope , Syncope, Vasovagal , UnconsciousnessABSTRACT
Objective: To explore the diagnostic value of head-up tilt test with sublingual isosorbide dinitrate （HUTSI）in patients with vasovagal syncope (VVS). Methods: A total of fifty-two consecutive patients with clinically vasovagal syncope (VVS group) and thirty-eight control subjects without prior experience of syncope (normal control group) were evaluated by baseline head-up tilt table test (BHUT) , then the BHUT negative subjects underwent HUTSI test. . Results: (1) Positive BHUT test rate of VVS group and normal control group were 25% (13/52) and 0 respectively; from supine to HUT positive, there were significant decrease in heart rate [(73.1±8.5) times/min vs. (56.2±11.2) times/min] and mean arterial pressure [MAP, (81.2± 10.8) mmHg vs. (50.2±10.4) mmHg，P<0.05 both] in BHUT positive subjects. There were 21 HUTSI positive cases（53.9%）among the other 39 VVS patients, and two cases（5.3%）among the 38 subjects of normal control group. From supine to HUTSI positive, there were significant decrease in heart rate [(65.2±7.5) times/min vs. (52.9±10.5) times/min] and MAP [(78.3±10.7) mmHg vs. (48.8±11.2) mmHg, P<0.05 both] in HUTSI positive subjects. Duration from tilt started to positive reaction occurred in HUTSI positive group was significantly shorter than that of BHUT positive group [(10.8±9.3) min vs. (21.1±11.5) min，P<0.05]. All subjects can tolerate the test and only two cases in VVS group and one case in normal control group occurred headache and face red. Conclusion: Head-up tilt test with sublingual isosorbide dinitrate is a practical and easy-to- perform method with high sensitivity, specificity and few side effects for diagnosis of vasovagal syncope.
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BACKGROUND/AIMS: This study elucidated the prognostic factors for neurocardiogenic syncope in males in their late teens and early twenties. METHODS: Tilt-table testing (TTT) was performed on 665 males (age range, 17 to 27 years) following the Italian protocol. The subjects were tilted head-up at a 70degrees angle on a table for 30 minutes during the passive phase. If the passive phase was negative, the subjects were given sublingual nitroglycerin and tilted to the same angle for 20 minutes during the drug-provocation phase. The subjects with positive results were followed without medication. We analyzed factors related to the recurrence rate of syncope. RESULTS: Of 305 subjects (45.8%) with positive results, 223 (age range, 18 to 26 years) were followed for 12 months. The frequency of previous syncopal episodes > or = 4 (p = 0.001) and a positive result during the passive phase (p = 0.022) were significantly related to a high recurrence rate. A positive result during the early passive phase ( 12 minutes; p = 0.011). CONCLUSIONS: A positive result during the early passive phase of TTT and frequent previous syncopal episodes were prognostic factors for neurocardiogenic syncope in men in their late teens and early twenties.