Syncope

Neurologic Clinics

Volumn 29, Issue 4, 2011, Pages 903-925

  Angaran, Paul ^a   Klein, George J ^a   Yee, Raymond ^a   Skanes, Allan C ^a   Gula, Lorne J ^a   Leong Sit, Peter ^a   Krahn, Andrew D ^a  

^a UNIVERSITY OF WESTERN ONTARIO   (Canada)

Author keywords

Diagnosis; Neurocardiogenic syncope; Syncope; Vasovagal

Indexed keywords

ALPHA ADRENERGIC RECEPTOR STIMULATING AGENT; ANTIARRHYTHMIC AGENT; ANTIHYPERTENSIVE AGENT; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; DISOPYRAMIDE; ETILEFRINE; FLUDROCORTISONE; METOPROLOL; MIDODRINE; PAROXETINE; PLACEBO;

ADJUSTMENT DISORDER; CARDIAC IMAGING; CARDIOVASCULAR DISEASE; CAROTID SINUS SYNDROME; CATHETER ABLATION; CLINICAL TRIAL (TOPIC); DEFIBRILLATION; ELECTROCARDIOGRAPHY MONITORING; ELECTROPHYSIOLOGY; EXERCISE TEST; HEAD TILTING; HEART ARRHYTHMIA; HEART HEMODYNAMICS; HEART PACING; HEART VENTRICLE TACHYCARDIA; HUMAN; INCONTINENCE; LABORATORY TEST; MULTICENTER STUDY (TOPIC); ORTHOSTATIC HYPOTENSION; PHYSICAL EXAMINATION; PRIORITY JOURNAL; PROGNOSIS; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; SYNCOPE; TRANSIENT ISCHEMIC ATTACK;

ARRHYTHMIAS, CARDIAC; DIAGNOSIS, DIFFERENTIAL; ELECTROCARDIOGRAPHY; HUMANS; HYPOTENSION, ORTHOSTATIC; PHYSICAL EXAMINATION; SYNCOPE; TILT-TABLE TEST;

EID: 80055111892     PISSN: 07338619     EISSN: 15579875     Source Type: Journal    
DOI: 10.1016/j.ncl.2011.07.005     Document Type: Review

References (102)

1. Soteriades E.S., Evans J.C., Larson M.G., et al. Incidence and prognosis of syncope. N Engl J Med 2002, 347(12):878-885.
2. Day S.C., Cook E.F., Funkenstein H., et al. Evaluation and outcome of emergency room patients with transient loss of consciousness. Am J Med 1982, 73(1):15-23.
3. Doherty J.U., Pembrook-Rogers D., Grogan E.W., et al. Electrophysiologic evaluation and follow-up characteristics of patients with recurrent unexplained syncope and presyncope. Am J Cardiol 1985, 55(6):703-708.
4. Morichetti A., Astorino G. Minerva Med 1998, 89(6):211-220.
5. Alshekhlee A., Shen W.K., Mackall J., et al. Incidence and mortality rates of syncope in the United States. Am J Med 2009, 122(2):181-188.
6. Sun B.C., Emond J.A., Camargo C.A. Direct medical costs of syncope-related hospitalizations in the United States. Am J Cardiol 2005, 95(5):668-671.
7. Kapoor W.N. Evaluation and outcome of patients with syncope. Medicine (Baltimore) 1990, 69(3):160-175.
8. Grubb B.P. Clinical practice. Neurocardiogenic syncope. N Engl J Med 2005, 352(10):1004-1010.
9. Colman N., Nahm K., Ganzeboom K.S., et al. Epidemiology of reflex syncope. Clin Auton Res 2004, 14(Suppl 1):9-17.
10. Ganzeboom K.S., Colman N., Reitsma J.B., et al. Prevalence and triggers of syncope in medical students. Am J Cardiol 2003, 91(8):1006-1008. A1008.
11. Serletis A., Rose S., Sheldon A.G., et al. Vasovagal syncope in medical students and their first-degree relatives. Eur Heart J 2006, 27(16):1965-1970.
12. Gregoratos G., Cheitlin M.D., Conill A., et al. ACC/AHA Guidelines for implantation of Cardiac Pacemakers and Antiarrhythmia Devices: Executive Summary-a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation). Circulation 1998, 97(13):1325-1335.
13. Kenny R.A., Ingram A., Bayliss J., et al. Head-up tilt: a useful test for investigating unexplained syncope. Lancet 1986, 1(8494):1352-1355.
14. Bonyhay I., Freeman R. Sympathetic nerve activity in response to hypotensive stress in the postural tachycardia syndrome. Circulation 2004, 110(20):3193-3198.
15. Fu Q., Vangundy T.B., Galbreath M.M., et al. Cardiac origins of the postural orthostatic tachycardia syndrome. J Am Coll Cardiol 2010, 55(25):2858-2868.
16. Stewart J.M. Autonomic nervous system dysfunction in adolescents with postural orthostatic tachycardia syndrome and chronic fatigue syndrome is characterized by attenuated vagal baroreflex and potentiated sympathetic vasomotion. Pediatr Res 2000, 48(2):218-226.
17. Raj S.R., Robertson D. Blood volume perturbations in the postural tachycardia syndrome. Am J Med Sci 2007, 334(1):57-60.
18. Mosqueda-Garcia R., Furlan R., Tank J., et al. The elusive pathophysiology of neurally mediated syncope. Circulation 2000, 102(23):2898-2906.
19. Kosinski D., Grubb B.P., Temesy-Armos P. Pathophysiological aspects of neurocardiogenic syncope: current concepts and new perspectives. Pacing Clin Electrophysiol 1995, 18(4 Pt 1):716-724.
20. Morillo C.A., Eckberg D.L., Ellenbogen K.A., et al. Vagal and sympathetic mechanisms in patients with orthostatic vasovagal syncope. Circulation 1997, 96(8):2509-2513.
21. Shy G.M., Drager G.A. A neurological syndrome associated with orthostatic hypotension: a clinical-pathologic study. Arch Neurol 1960, 2:511-527.
22. Shibao C., Grijalva C.G., Raj S.R., et al. Orthostatic hypotension-related hospitalizations in the United States. Am J Med 2007, 120(11):975-980.
23. Robertson D., Robertson R.M. Causes of chronic orthostatic hypotension. Arch Intern Med 1994, 154(14):1620-1624.
24. Brignole M., Alboni P., Benditt D., et al. Guidelines on management (diagnosis and treatment) of syncope. Eur Heart J 2001, 22(15):1256-1306.
25. Linzer M., Yang E.H., Estes N.A., et al. Diagnosing syncope. Part 1: value of history, physical examination, and electrocardiography. Clinical Efficacy Assessment Project of the American College of Physicians. Ann Intern Med 1997, 126(12):989-996.
26. Krahn A.D., Klein G.J., Yee R., et al. The use of monitoring strategies in patients with unexplained syncope-role of the external and implantable loop recorder. Clin Auton Res 2004, 14(Suppl 1):55-61.
27. Brignole M., Menozzi C., Bartoletti A., et al. A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals. Eur Heart J 2006, 27(1):76-82.
28. Lempert T., Bauer M., Schmidt D. Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia. Ann Neurol 1994, 36(2):233-237.
29. Sheldon R., Rose S., Ritchie D., et al. Historical criteria that distinguish syncope from seizures. J Am Coll Cardiol 2002, 40(1):142-148.
30. Adams R. Cases of disease of the heart, accompanied with pathological observations. Dublin Hospital Reports 1827, 4:353. [abstract].
31. Stokes W. Observations on some cases of permanently slow pulse. Dublin Quarterly Journal of Medical Science 1846, 2:73. [abstract].
32. Del Rosso A., Ungar A., Maggi R., et al. Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score. Heart 2008, 94(12):1620-1626.
33. Sheldon R., Rose S., Connolly S., et al. Diagnostic criteria for vasovagal syncope based on a quantitative history. Eur Heart J 2006, 27(3):344-350.
34. Waxman M.B., Wald R.W., Sharma A.D., et al. Vagal techniques for termination of paroxysmal supraventricular tachycardia. Am J Cardiol 1980, 46(4):655-664.
35. Sugrue D.D., Gersh B.J., Holmes D.R., et al. Symptomatic " isolated" carotid sinus hypersensitivity: natural history and results of treatment with anticholinergic drugs or pacemaker. J Am Coll Cardiol 1986, 7(1):158-162.
36. Davies A.J., Kenny R.A. Frequency of neurologic complications following carotid sinus massage. Am J Cardiol 1998, 81(10):1256-1257.
37. Brignole M., Alboni P., Benditt D.G., et al. Guidelines on management (diagnosis and treatment) of syncope-update 2004. Europace 2004, 6(6):467-537.
38. Kapoor W.N., Karpf M., Maher Y., et al. Syncope of unknown origin. The need for a more cost-effective approach to its diagnosis evaluation. JAMA 1982, 247(19):2687-2691.
39. Recchia D., Barzilai B. Echocardiography in the evaluation of patients with syncope. J Gen Intern Med 1995, 10(12):649-655.
40. Benditt D.G., Ferguson D.W., Grubb B.P., et al. Tilt table testing for assessing syncope. American College of Cardiology. J Am Coll Cardiol 1996, 28(1):263-275.
41. Brignole M., Menozzi C., Del Rosso A., et al. New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification. Analysis of the pre-syncopal phase of the tilt test without and with nitroglycerin challenge. Vasovagal Syncope International Study. Europace 2000, 2(1):66-76.
42. Sheldon R., Killam S. Methodology of isoproterenol-tilt table testing in patients with syncope. J Am Coll Cardiol 1992, 19(4):773-779.
43. Sutton R., Petersen M., Brignole M., et al. Proposed classification for tilt induced vasovagal syncope. Eur J Cardiac Pacing Electrophysiol 1992, 2:180-183.
44. Kapoor W.N., Smith M.A., Miller N.L. Upright tilt testing in evaluating syncope: a comprehensive literature review. Am J Med 1994, 97(1):78-88.
45. Natale A., Akhtar M., Jazayeri M., et al. Provocation of hypotension during head-up tilt testing in subjects with no history of syncope or presyncope. Circulation 1995, 92(1):54-58.
46. Petersen M.E., Williams T.R., Gordon C., et al. The normal response to prolonged passive head up tilt testing. Heart 2000, 84(5):509-514.
47. Grubb B.P., Kosinski D.J., Boehm K., et al. The postural orthostatic tachycardia syndrome: a neurocardiogenic variant identified during head-up tilt table testing. Pacing Clin Electrophysiol 1997, 20(9 Pt 1):2205-2212.
48. Naschitz J.E., Gaitini L., Mazov I., et al. The capnography-tilt test for the diagnosis of hyperventilation syncope. QJM 1997, 90(2):139-145.
49. Petersen M.E., Williams T.R., Sutton R. Psychogenic syncope diagnosed by prolonged head-up tilt testing. QJM 1995, 88(3):209-213.
50. Krahn A.D., Yee R., Klein G.J., et al. Inappropriate sinus tachycardia: evaluation and therapy. J Cardiovasc Electrophysiol 1995, 6:1124-1128.
51. Linzer M., Yang E.H., Estes N.A., et al. Diagnosing syncope. Part 2: unexplained syncope. Clinical Efficacy Assessment Project of the American College of Physicians. Ann Intern Med 1997, 127(1):76-86.
52. Olshansky B., Poole J.E., Johnson G., et al. Syncope predicts the outcome of cardiomyopathy patients: analysis of the SCD-HeFT study. J Am Coll Cardiol 2008, 51(13):1277-1282.
53. Fuster V., Ryden L.E., Cannom D.S., et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation). Eur Heart J 2006, 27(16):1979-2030.
54. Fujimura O., Yee R., Klein G.J., et al. The diagnostic sensitivity of electrophysiologic testing in patients with syncope caused by transient bradycardia. N Engl J Med 1989, 321(25):1703-1707.
55. Krahn A.D., Klein G.J., Norris C., et al. The etiology of syncope in patients with negative tilt table and electrophysiological testing. Circulation 1995, 92(7):1819-1824.
56. Brignole M., Menozzi C., Moya A., et al. Mechanism of syncope in patients with bundle branch block and negative electrophysiological test. Circulation 2001, 104(17):2045-2050.
57. Kapoor W.N. Evaluation and management of the patient with syncope. JAMA 1992, 268(18):2553-2560.
58. Krahn A.D., Klein G.J., Yee R., et al. Predictive value of presyncope in patients monitored for assessment of syncope. Am Heart J 2001, 141(5):817-821.
59. Brown A.P., Dawkins K.D., Davies J.G. Detection of arrhythmias: use of a patient-activated ambulatory electrocardiogram device with a solid-state memory loop. Br Heart J 1987, 58(3):251-253.
60. Cumbee S.R., Pryor R.E., Linzer M. Cardiac loop ECG recording: a new noninvasive diagnostic test in recurrent syncope. South Med J 1990, 83(1):39-43.
61. Linzer M., Pritchett E.L., Pontinen M., et al. Incremental diagnostic yield of loop electrocardiographic recorders in unexplained syncope. Am J Cardiol 1990, 66(2):214-219.
62. Reiffel J.A., Schwarzberg R., Murry M. Comparison of autotriggered memory loop recorders versus standard loop recorders versus 24-hour Holter monitors for arrhythmia detection. Am J Cardiol 2005, 95(9):1055-1059.
63. Sivakumaran S., Krahn A.D., Klein G.J., et al. A prospective randomized comparison of loop recorders versus Holter monitors in patients with syncope or presyncope. Am J Med 2003, 115(1):1-5.
64. Gula L.J., Krahn A.D., Massel D., et al. External loop recorders: determinants of diagnostic yield in patients with syncope. Am Heart J 2004, 147(4):644-648.
65. Krahn A.D., Klein G.J., Fitzpatrick A., et al. Predicting the outcome of patients with unexplained syncope undergoing prolonged monitoring. Pacing Clin Electrophysiol 2002, 25(1):37-41.
66. Krahn A.D., Klein G.J., Yee R., et al. Final results from a pilot study with an implantable loop recorder to determine the etiology of syncope in patients with negative noninvasive and invasive testing. Am J Cardiol 1998, 82(1):117-119.
67. Krahn A.D., Klein G.J., Yee R., et al. Randomized assessment of syncope trial: conventional diagnostic testing versus a prolonged monitoring strategy. Circulation 2001, 104(1):46-51.
68. Krahn A.D., Klein G.J., Yee R., et al. Use of an extended monitoring strategy in patients with problematic syncope. Reveal Investigators. Circulation 1999, 99(3):406-410.
69. Edvardsson N., Frykman V., van Mechelen R., et al. Use of an implantable loop recorder to increase the diagnostic yield in unexplained syncope: results from the PICTURE registry. Europace 2011, 13(2):262-269.
70. Zaidi A., Clough P., Cooper P., et al. Misdiagnosis of epilepsy: many seizure-like attacks have a cardiovascular cause. J Am Coll Cardiol 2000, 36(1):181-184.
71. Zaidi A., Clough P., Mawer G., et al. Accurate diagnosis of convulsive syncope: role of an implantable subcutaneous ECG monitor. Seizure 1999, 8(3):184-186.
72. Moya A., Brignole M., Menozzi C., et al. Mechanism of syncope in patients with isolated syncope and in patients with tilt-positive syncope. Circulation 2001, 104(11):1261-1267.
73. Krahn A.D., Klein G.J., Yee R., et al. Cost implications of testing strategy in patients with syncope: randomized assessment of syncope trial. J Am Coll Cardiol 2003, 42(3):495-501.
74. Brignole M., Sutton R., Menozzi C., et al. Early application of an implantable loop recorder allows effective specific therapy in patients with recurrent suspected neurally mediated syncope. Eur Heart J 2006, 27(9):1085-1092.
75. Brignole M. International study on syncope of uncertain aetiology 3 (ISSUE 3): pacemaker therapy for patients with asystolic neurally-mediated syncope: rationale and study design. Europace 2007, 9(1):25-30.
76. Di Girolamo E., Di Iorio C., Leonzio L., et al. Usefulness of a tilt training program for the prevention of refractory neurocardiogenic syncope in adolescents: a controlled study. Circulation 1999, 100(17):1798-1801.
77. van Dijk N., Quartieri F., Blanc J.J., et al. Effectiveness of physical counterpressure maneuvers in preventing vasovagal syncope: the Physical Counterpressure Manoeuvres Trial (PC-Trial). J Am Coll Cardiol 2006, 48(8):1652-1657.
78. Cox M.M., Perlman B.A., Mayor M.R., et al. Acute and long-term beta-adrenergic blockade for patients with neurocardiogenic syncope. J Am Coll Cardiol 1995, 26(5):1293-1298.
79. Natale A., Sra J., Dhala A., et al. Efficacy of different treatment strategies for neurocardiogenic syncope. Pacing Clin Electrophysiol 1995, 18(4 Pt 1):655-662.
80. Ventura R., Maas R., Zeidler D., et al. A randomized and controlled pilot trial of beta-blockers for the treatment of recurrent syncope in patients with a positive or negative response to head-up tilt test. Pacing Clin Electrophysiol 2002, 25(5):816-821.
81. Sheldon R., Connolly S., Rose S., et al. Prevention of Syncope Trial (POST): a randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope. Circulation 2006, 113(9):1164-1170.
82. Klingenheben T., Credner S., Hohnloser S.H. Prospective evaluation of a two-step therapeutic strategy in neurocardiogenic syncope: midodrine as second line treatment in patients refractory to beta-blockers. Pacing Clin Electrophysiol 1999, 22(2):276-281.
83. Mitro P., Trejbal D., Rybar A.R. Midodrine hydrochloride in the treatment of vasovagal syncope. Pacing Clin Electrophysiol 1999, 22(11):1620-1624.
84. Samniah N., Sakaguchi S., Lurie K.G., et al. Efficacy and safety of midodrine hydrochloride in patients with refractory vasovagal syncope. Am J Cardiol 2001, 88(1):A7. 80-3.
85. Ward C.R., Gray J.C., Gilroy J.J., et al. Midodrine: a role in the management of neurocardiogenic syncope. Heart 1998, 79(1):45-49.
86. Raviele A., Brignole M., Sutton R., et al. Effect of etilefrine in preventing syncopal recurrence in patients with vasovagal syncope: a double-blind, randomized, placebo-controlled trial. The Vasovagal Syncope International Study. Circulation 1999, 99(11):1452-1457.
87. Morillo C.A., Leitch J.W., Yee R., et al. A placebo-controlled trial of intravenous and oral disopyramide for prevention of neurally mediated syncope induced by head-up tilt. J Am Coll Cardiol 1993, 22(7):1843-1848.
88. Di Girolamo E., Di Iorio C., Sabatini P., et al. Effects of paroxetine hydrochloride, a selective serotonin reuptake inhibitor, on refractory vasovagal syncope: a randomized, double-blind, placebo-controlled study. J Am Coll Cardiol 1999, 33(5):1227-1230.
89. Ammirati F., Colivicchi F., Santini M. Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope: a multicenter, randomized, controlled trial. Circulation 2001, 104(1):52-57.
90. Connolly S.J., Sheldon R., Roberts R.S., et al. The North American Vasovagal Pacemaker Study (VPS). A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. J Am Coll Cardiol 1999, 33(1):16-20.
91. Sutton R., Brignole M., Menozzi C., et al. Dual-chamber pacing in the treatment of neurally mediated tilt-positive cardioinhibitory syncope: pacemaker versus no therapy: a multicenter randomized study. The Vasovagal Syncope International Study (VASIS) Investigators. Circulation 2000, 102(3):294-299.
92. Connolly S.J., Sheldon R., Thorpe K.E., et al. Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope: Second Vasovagal Pacemaker Study (VPS II): a randomized trial. JAMA 2003, 289(17):2224-2229.
93. Raviele A., Giada F., Menozzi C., et al. A randomized, double-blind, placebo-controlled study of permanent cardiac pacing for the treatment of recurrent tilt-induced vasovagal syncope. The vasovagal syncope and pacing trial (SYNPACE). Eur Heart J 2004, 25(19):1741-1748.
94. Sud S., Massel D., Klein G.J., et al. The expectation effect and cardiac pacing for refractory vasovagal syncope. Am J Med 2007, 120(1):54-62.
95. Kenny R.A., Richardson D.A., Steen N., et al. Carotid sinus syndrome: a modifiable risk factor for nonaccidental falls in older adults (SAFE PACE). J Am Coll Cardiol 2001, 38(5):1491-1496.
96. Rattes M.F., Klein G.J., Sharma A.D., et al. Efficacy of empirical cardiac pacing in syncope of unknown cause. CMAJ 1989, 140(4):381-385.
97. Pires L.A., May L.M., Ravi S., et al. Comparison of event rates and survival in patients with unexplained syncope without documented ventricular tachyarrhythmias versus patients with documented sustained ventricular tachyarrhythmias both treated with implantable cardioverter-defibrillators. Am J Cardiol 2000, 85(6):725-728.
98. Mittal S., Iwai S., Stein K.M., et al. Long-term outcome of patients with unexplained syncope treated with an electrophysiologic-guided approach in the implantable cardioverter-defibrillator era. J Am Coll Cardiol 1999, 34(4):1082-1089.
99. Moss A.J., Zareba W., Hall W.J., et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002, 346(12):877-883.
100. Bardy G.H., Lee K.L., Mark D.B., et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005, 352(3):225-237.
101. Buxton A.E., Lee K.L., Fisher J.D., et al. A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators. N Engl J Med 1999, 341(25):1882-1890.
102. Klein G.J., Gersh B.J., Yee R. Electrophysiological testing. The final court of appeal for diagnosis of syncope?. Circulation 1995, 92(5):1332-1335.