Current trends in etiology, diagnosis, and management of neurocardiogenic syncope

Current Opinion in Cardiology

Volumn 11, Issue 1, 1996, Pages 32-41

  Grubb, Blair P ^a   Kosinski, Daniel ^a  

^a MEDICAL COLLEGE OF OHIO   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ALCOHOL; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; DISOPYRAMIDE; DOPAMINE; FLUDROCORTISONE; FLUOXETINE; ISOPRENALINE; METHYLPHENIDATE; METOPROLOL; NITRIC ACID DERIVATIVE; PRAZOSIN; PSEUDOEPHEDRINE; SCOPOLAMINE; SERTRALINE; THEOPHYLLINE; TRICYCLIC ANTIDEPRESSANT AGENT;

BRADYCARDIA; CLINICAL FEATURE; HUMAN; HYPOTENSION; MEDICAL ASSESSMENT; ORAL DRUG ADMINISTRATION; PATHOPHYSIOLOGY; PRIORITY JOURNAL; RECURRENT DISEASE; REVIEW; SYNCOPE; TILTING; TRANSDERMAL DRUG ADMINISTRATION; UNCONSCIOUSNESS;

ANIMALS; HUMANS; RECURRENCE; SYMPATHETIC NERVOUS SYSTEM; SYNCOPE; TILT-TABLE TEST;

EID: 0029962181     PISSN: 02684705     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001573-199601000-00006     Document Type: Review

References (68)

1. Kapoor W, Karpf M, Wieand S, Peterson J, Levey G: A prospective evaluation and followup of patients with syncope. N Engl J Med 1983, 309:197-204.
2. Decter BM, Goldner B, Cohen TJ: Vasovagal syncope as a cause of motor vehicle accidents. Am Heart J 1994, 127:1619-1621.
3. Linzer M, Pontinen M, Gold GT: Impairment of physical and psychosocial function in recurrent syncope. J Clin Epidemiol 1991, 44:1037-1043.
4. Calkins H, Byrne M, El-Atassi R, Kalbfleish S, Langley JJ, Morady F: The economic burden of unrecognized vasodepressor syncope. Am J Med 1993, 95:473-479.
5. Kosinski D, Grubb BP: Neurally mediated syncope with an update in indications and usefulness of head upright tilt table testing and pharmacologic therapy. Curr Opin Cardiol 1994, 9:53-64.
6. Wieling W, Lieshout J: Maintenance of postural normotension in humans. In Clinical Autonomic Disorders. Edited by Low P. Boston: Little, Brown and Co; 1993:69-78.
7. Rea R, Thames MD: Neural control mechanisms and vasovagal syncope. J Cardiovasc Electrophysiol 1993, 4:587-595.
8. Kosinski D, Grubb BP, Temesy-Armos P: Pathophysiological aspects of neurocardiogenic syncope. PACE Pacing Clin Electrophysiol 1995, 18:716-721. A comprehensive review of our current understanding of the pathophysiology of neurocardiogenic syncope.
9. Mehdriad AA, Janosik D, Fredman C: Mechanisms of tilt table induced hypotension and bradycardia in patients with neurally mediated syncope [abstract]. J Am Coll Cardiol 1991, 17:216A.
10. Fitzpatrick A, Banner N, Cheng A, et al.: Vasovagal reactions may occur after orthotopic heart transplantation. J Am Coll Cardiol 1993, 21:1132-1137.
11. Chosy JJ, Graham DT: Catecholamines in vasovagal fainting. J Psychosom Res 1965, 9:189-194.
12. Sra J, Jazayeri M, Murthy V, et al.: Sequential catecholamine changes during upright tilt: possible hormonal mechanisms responsible for pathogenesis of neurocardiogenic syncope [abstract]. J Am Coll Cardiol 1991, 17:216A.
13. Hackel A, Linzer M, Anderson N, Williams R: Cardiovascular and catecholamine responses to head up tilt in the diagnosis of recurrent unexplained syncope in elderly patients. J Am Geriatr Soc 1991, 39:663-669.
14. Lewis W, Smith M, Carlson M: Peripheral sympathoinhibition precedes hypotension and bradycardia during neurally-mediated vasovagal syncope [abstract]. PACE Pacing Clin Electrophysiol 1994, 17:747.
15. Almquist A, Goldenberg IF, Milstein S, Chen M, Chen X, Hanson R, Gornick C, Benditt D: Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope. N Engl J Med 1989, 320:346-351.
16. Fitzpatrick A, Williams T, Ahmed R, et al.: Echocardiographic and endocrine changes during vasovagal syncope induced by prolonged head up tilt. Eur J Cardiac Pacing Electrophysiol 1992, 2:121-128.
17. Skoog P, Mansson J, Theen P: Changes in renal sympathetic outflow during hypotensive hemorrhage in rats. Acta Physiol Scand 1985, 125:655-660.
18. Morgan DA, Thoren P, Wilczynski E, Victor RG, Mark A: Serotonergic mechanisms mediate renal sympathoinhibition during severe hemorrhage in rats. Am J Physiol 1988, 255:H496-H502.
19. Evans RG, Kapoor V, Ludbrook J: A CNS serotonergic mechanism in acute central hypovolemia in conscious rabbits? J Cardiovasc Pharmacol 1992, 19:1009-1017.
20. Kuhn D, Wolfe W, Lovenberg W: Review of the role of the central serotonergic neuronal system in blood pressure regulation. Hypertension 1980, 2:243-245.
21. Abboud F: Neurocardiogenic syncope. N Engl J Med 1993, 328:1117-1119.
22. Kosinski D, Grubb BP, Temesy-Armos P: The use of serotonin reuptake inhibitors in the treatment of neurally-mediated cardiovascular disorders. J Serotonin Res 1994, 1:85-90.
23. Grubb BP, Wolfe DA, Samoil D, Temesy-Armos P, Hahn H, Elliott L: Usefulness of fluoxetine hydrochloride in the treatment of resistant upright tilt-induced syncope. PACE Pacing Clin Electrophysiol 1993, 16:458-464.
24. Grubb BP, Samoil D, Kosinski D, Kip K: The use of sertraline hydrochloride in the treatment of refractory neurocardiogenic syncope in children and adolescents. J Am Coll Cardiol 1994, 24:490-494.
25. Jacobs B, Azmita E: Structure and function of the brain serotonin system. Physiol Rev 1992, 72:165-229.
26. Monta H, Nishida Y, Motochigawa H. Opiate receptor mediated decrease in renal nerve activity during hypotensive hemorrhage in conscious rats. Circ Res 1988, 63:165-172.
27. Evans RG, Ludbrook J, Porocnik SJ: Intracisternal naloxone and cardiac nerve blockage prevent vasodilation during simulated hemorrhage in awake rabbits. J Physiol (London) 1989, 409:1-14.
28. Ferguson DW: Naloxone potentiates cardiopulmonary baroreflex sympathetic control in normal humans. Circ Res 1992, 70:172-183.
29. Perna GP, Ficola U, Salvatori P: Increase of plasma β endorphins in vasodepressor syncope. Am J Cardiol 1990, 65:929-930.
30. Smith ML, Carlson MD, Sheehan HM: Naloxone does not prevent vasovagal syncope during simulated orthostasis in humans. Physiologist 1991, 34:238-239.
31. Grubb BP, Gerard G, Roush K, Temesy-Armos P, Montford P, Elliott L, Hahn H, Brewster P: Cerebral vasoconstriction during head upright tilt-induced vasovagal syncope. Circulation 1991, 84:1157-1164.
32. Janosik D, Gomez C, Njemanze P, Greenwelt T: Abnormalities in cerebral blood flow autoregulation during tilt-Induced syncope [abstract]. PACE Pacing Clin Electrophysiol 1992, 15:542.
33. Njemanze P. Cerebral circulation dysfunction and hemodynamic abnormalities in syncope during head up tilt test. Can J Cardiol 1993, 9:238-242.
34. Nelson RJ, Perry S, Hames TK, Pickard JD: Transcranial Doppler ultrasound studies of cerebral autoregulation and subarachnoid hemorrhage in the rabbit. J Neurosurg 1990, 73:601-608.
35. Giller C, Levine B, Meyer T, et al.: The cerebral hemodynamics of normotensive hypovolemia during lower body negative pressure. J Neurosurg 1992, 76:961-966.
36. Kammer S, Truemper E, Fisher A: Recurrent pre-syncope in children: intracranial hemodynamics [abstract]. PACE Pacing Clin Electrophysiol 1993, 1:532.
37. Wayne HH: Syncope: Physiologic considerations and an analysis of the clinical characteristics in 510 patients. Am J Med 1961, 30:418-438.
38. Luft NC, Noell WK: Manifestations of brief instantaneous anoxia in men. J Appl Physiol 1956, 8:444-454.
39. Grubb BP, Gerard G, Roush K, Temesy-Armos P, Elliott L, Hahn H, Spann C: Differentiation of convulsive syncope and epilepsy with head up tilt testing. Ann Intern Med 1991, 115:871-876.
40. Stevens H, Fazekas J: Experimentally induced hypotension. Arch Neurol Psych 1955, 73:416-424.
41. Kenny RA, Ingram A, Baytess J, Sutton R: Head up tilt: a useful test for investigating unexplained syncope. Lancet 1989, 1:1352-1355.
42. Fitzpatrick A, Sutton R: Tilting toward a diagnosis in unexplained syncope. Lancet 1989, 1:658-660.
43. Benditt DG, Remole S, Balin S, Dunnigan A, Asso A, Milstein S: Tilt table testing for evaluation of neurally-mediated (cardioneurogenic) syncope: rationale and proposed protocols. PACE Pacing Clin Electrophysiol 1991, 14:1528-1537.
44. Samoil D, Grubb BP: Vasovagal (neurally-mediated) syncope: pathophysiology, diagnosis and therapeutic approach. Eur J Cardiac Pacing Electrophysiol 1992, 4:234-241.
45. Morillo CA, Klein GJ, Zandri S, Yea R: Diagnostic accuracy of a low-dose isoproterenol head up tilt protocol. Am Heart J 1995, 129:901-908.
46. Natale A, Akhtar M, Jazayeri M, Dhola A, Blank Z, Deshpande S, Krebs A, Sra J: Provocation of hypotension during head up tilt testing in subjects with no history of syncope or presyncope. Circulation 1995, 92:54-58. Another excellent and comprehensive study evaluating the accuracy of a low-dose isoproterenol tilt-table study.
47. Mizumaki K, Fujiki A, Tani M, Shimono M, Hayasha H, Inove H: Left ventricular dimensions and autonomic balance during head up tilt differ between patients with isoproterenol-dependent and isoproterenol-independent neurally mediated syncope. J Am Coll Cardiol 1995, 26:164-173.
48. Grubb BP, Wolfe D, Gerard G, Samoil D, Davenport C, Homan R, Temesy-Armos P: Syncope and seizures of psychogenic origin: identification with head upright tilt table testing. Clin Cardiol 1992, 15:834-842.
49. Sutton R, Peterson M, Brignole M, Raviele A, Menozzi C, Giani P: Proposed classification for tilt-induced vasovagal syncope. Eur J Cardiac Pacing Electrophysiol 1992, 2:180-183.
50. Sra JS, Murphy VS, Jazayeri MR, Shen Y, Trop RJ, Avitall B, Akhtar M: Use of intravenous esmolol to predict efficacy of oral β blocker therapy in patients with neurocardiogenic syncope. J Am Coll Cardiol 1992, 19:402-408.
51. Davgovian M, Jarardilla R, Frumin H: Prolonged asystole during head upright tilt table testing after β blockage. PACE Pacing Clin Electrophysiol 1992, 15:14-16.
52. Lippman N, Lerman B: Differential responses to therapy with β blockers in patients with isoproterenol dependent and independent neurocardiogenic syncope [abstract]. Circulation 1992, 86:578.
53. Jaeger FJ, Fouad-Tarazi FM, Abi-Samra FM, Crose RF, Castle LW, Maloney JD: Transdermal scopolamine for treatment of vasovagal syncope [abstract]. Clin Res 1987, 35:822.
54. Milstein S, Buetikofer J, Dunnigan A, Benditt DG, Gornick C, Reyes WJ: Usefulness of disopyramide for prevention of upright tilt-induced hypotension bradycardia. Am J Cardiol 1990, 65:1339-1344.
55. Morillo CA, Leitch JW, Yee R, Klein GJ: A placebo controlled trial of neurally-mediated syncope induced by head up tilt. J Am Coll Cardiol 1993, 22:1843-1848.
56. Nelson S, Stanley M, Love C, Cyne K, Schaal S: Autonomic and hemodynamic effects of oral theophylline in patients with vasodepressor syncope. Arch Intern Med 1991, 151:2425-2429.
57. Strieper M, Campbell R: Efficacy of α-adrenergic agonist therapy for the prevention of pediatric neurocardlogenic syncope. J Am Coll Cardiol 1993, 22:594-597.
58. Susmano A, Volgman A, Buckinham T: Beneficial effects of dextro-amphetamine in the treatment of vasodepressor syncope. PACE Pacing Clin Electrophysiol 1993, 16:1235-1238.
59. Grubb BP, Kosinski D, Kip K: Utility of methylphenidate in the therapy of refractory neurocardiogenic syncope. PACE Pacing Clin Electrophysiol, in press.
60. Hjorth S: Penbutolol as a blocker of central 5HT-1A receptor mediated responses. Eur J Pharmacol 1992, 222:121-127.
61. McGrady A, Bernal G: Relaxation based treatment of stress-induced syncope. J Behav Ther Exp Psychiatry 1986, 17:23-27.
62. Fitzpatrick A, Theodorakis G, Ahmed R, Williams T, Sutton R: Dual chamber pacing aborts vasovagal syncope induced by head up 60 degree tilt. PACE Pacing Clin Electrophysiol 1991, 14:13-19.
63. Samoil D, Grubb BP, Brewstar P, Moore J, Temesy-Armos P: Comparison of single and dual chamber pacing techniques in prevention of upright tilt-Induced vasovagal syncope. Eur J Cardiac Pacing Electrophysiol 1993, 1:36-41.
64. McGuinn P, Moore S, Edel T: Temporary dual chamber pacing during tilt table testing for vasovagal syncope: a predictor of therapeutic success [abstract]. PACE Pacing Clin Electrophysiol 1991, 14:734.
65. Sra JS, Jazayeri MR, Avitall B, Dhala A, Deshpande S, Blanck Z, Akhtar M: Comparison of cardiac pacing with drug therapy in the treatment of neurocardiogenic syncope with bradycardia or asystole. N Engl J Med 1993, 328:1085-1090.
66. Petersen ME, Chamberlain-Webber R, Fitzpatrick AP, Ingram A, Williams T, Sutton R: Permanent pacing for cardioinhibitory malignant vasovagal syndrome. Br Heart J 1994, 71:274-281.
67. Benditt DG, Petersen M, Lune K, Grubb BP, Sutton R: Cardiac pacing for prevention of recurrent vasovagal syncope. Ann Intern Med 1995, 122:204-209. A well-written and very complete review of cardiac pacing in neurocardiogenic syncope.
68. Grubb BP, Wolfe DA, Samoil D, Hahn H, Elliott L: Adaptive rate pacing controlled by right ventricular pre-ejection interval for severe refractory orthostatic hypotension. PACE Pacing Clin Electrophysiol 1993, 16:801-805.