scholarly journals Cardioneuroablation: Catheter Vagal Denervation as a New Therapy for Cardioinhibitory Syncope

2020 ◽  
Vol 32 (3) ◽  
pp. 182-196
Author(s):  
José Carlos Pachon Mateos ◽  
Enrique I Pachón Mateos ◽  
Christian Higuti ◽  
Tomas Guilhermo Santillana Peña ◽  
Tasso Julio Lobo ◽  
...  
Keyword(s):  
Heart Disease ◽  
Preventive Measures ◽  
Therapeutic Option ◽  
Vasovagal Syncope ◽  
Pacemaker Implantation ◽  
Young Patients ◽  
Loss Of Consciousness ◽  
Spectral Mapping ◽  
Transient Loss ◽  
Vagal Reflex

The vasovagal syncope is the most frequent cause of transient loss of consciousness, especially in young people without significant heart disease. The malignant cardioinhibitory form is caused by abrupt and intense vagal reflex with or without defined triggers. Refractory cases to preventive measures and pharmacological handling has been treated with definitive pacemaker implantation. Besides showing questionable results, pacemaker implantation is highly rejected by young patients. In the late 1990s, we proposed specific vagal denervation by catheter ablation and spectral mapping, for paroxysmal AF, functional bradyarrhythmias and severe cases of malignant cardioinhibitory syncope giving rise to cardioneuroablation. Recently, many authors worldwide have been reproducing the cardioneuroablation results where elimination or significant reduction of the vagal response were observed, which abolished symptoms in more than 75% of patients followed up to 14 years, without complications. Therefore, cardioneuroablation has shown to be a real therapeutic option in malignant syncope cardioinhibitory and in any exclusive vagal mediated bradyarrhythmia without the need for pacemaker implantation.

scholarly journals Sex and age impact prevalence and symptoms of vasovagal syncope: Implications for accurate diagnosis

2021 ◽  
pp. 1-3
Author(s):  
Hailey Gregson ◽  
Ana Ivkov
Keyword(s):  
Blood Flow ◽  
Spontaneous Recovery ◽  
Vasovagal Syncope ◽  
Common Type ◽  
Accurate Diagnosis ◽  
Loss Of Consciousness ◽  
Transient Loss Of Consciousness ◽  
Transient Loss ◽  
Autonomic Reflex ◽  
The Brain

Syncope is characterized by the transient loss of consciousness followed by spontaneous recovery. The mechanism which underlies this condition is reduced blood flow to the brain [1]. Vasovagal syncope, often termed reflex syncope, is the most common type of syncope [1]. Vasovagal Syncope is caused by the abnormal autonomic reflex to certain stimuli such as pain, micturition/defecation, fear, seeing blood, etc., which results in vasodilation and often times, bradycardia [1].

scholarly journals Aetiologies and temporal trends of atrioventricular block in young patients: a 20-year nationwide study

EP Europace ◽  
2019 ◽  
Vol 21 (11) ◽  
pp. 1710-1716 ◽  
Author(s):  
Johnni Rudbeck-Resdal ◽  
Morten K Christiansen ◽  
Jens B Johansen ◽  
Jens C Nielsen ◽  
Henning Bundgaard ◽  
...  
Keyword(s):  
Heart Disease ◽  
Atrioventricular Block ◽  
Temporal Trends ◽  
Pacemaker Implantation ◽  
Young Patients ◽  
Unknown Aetiology ◽  
Number Of Patients ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Abstract Aims To describe aetiologies and temporal trends in young patients with atrioventricular block (AVB). Methods and results We identified all patients in Denmark, receiving their first pacemaker because of AVB before the age of 50 years between 1996 and 2015. Medical records were reviewed and clinical information and diagnostic work-up results were obtained to evaluate the aetiology. We used Poisson regression testing for temporal trends. One thousand and twenty-seven patients were identified, median age at time of implantation was 38 (interquartile range 25–45) years, 584 (56.9%) were male. The aetiologies were complications to cardiac surgery [n = 157 (15.3%)], congenital AVB [n = 93 (9.0%)], cardioinhibitory reflex [n = 52 (5.0%)], congenital heart disease [n = 43 (4.2%)], complication to radiofrequency ablation [n = 35 (3.4%)], cardiomyopathy [n = 31 (3.0%)], endocarditis [n = 18 (1.7%)], muscular dystrophy [n = 14 (1.4%)], ischaemic heart disease [n = 14 (1.4%)], sarcoidosis [n = 11 (1.1%)], borreliosis [n = 9 (0.9%)], hereditary [n = 6 (0.6%)], side-effect to antiarrhythmics [n = 6 (0.6%)], planned His-ablation [n = 5 (0.5%)], complication to alcohol septal ablation [n = 5 (0.5%)], and other known aetiologies [n = 11 (1.1%)]. The aetiology remained unknown in 517 (50.3%) cases. While the number of patients with unknown aetiology increased during the study period (P < 0.001), we observed no significant change in the number of patients with identified aetiology (P = 0.35). Conclusion In a nationwide cohort, the aetiology of AVB was identified in only half the patients younger than 50 years referred for first-time pacemaker implantation. The number of patients with unknown aetiology increased during the study period. These findings indicate need for better insight into aetiologies of AVB and improved diagnostic work-up guidelines.

Cardioneuroablation as a method of therapy in vasovagal syncope

2020 ◽  
Vol 2 (55) ◽  
pp. 20-28
Author(s):  
Roman Piotrowski ◽  
Jakub Baran ◽  
Piotr Kułakowski
Keyword(s):  
Lifestyle Modification ◽  
Vasovagal Syncope ◽  
Treatment Method ◽  
Current Treatment ◽  
Loss Of Consciousness ◽  
Common Cause ◽  
Current State ◽  
Transient Loss ◽  
New Treatment

Vasovagal syncope is the most common cause of transient loss of consciousness, may significantly impair quality of life and lead to injury. Current treatment of vasovagal syncope is based on patient education, lifestyle modification, pharmacotherapy and, in extreme cases, implantation of a pacemaker. In recent years, more and more data on cardioneuroablation have been published – a new treatment method for neurally mediated asystolic syncope. This article summarizes the current state of knowledge about this method, presents indications for this procedure and shows perspectives for its development.

Syncope

2020 ◽  
pp. 5896-5901
Author(s):  
Andrew J. Larner
Keyword(s):  
Cardiac Output ◽  
Heart Disease ◽  
Physical Examination ◽  
Specific Treatment ◽  
Cerebral Hypoperfusion ◽  
Loss Of Consciousness ◽  
Body Parts ◽  
Transient Loss Of Consciousness ◽  
History Of ◽  
Transient Loss

Syncope is the most common identified cause of transient loss of consciousness, being ten times more frequent than epilepsy. It is a consequence of cerebral hypoperfusion due to reduced cardiac output, often related to reduced venous return due to decreased peripheral vascular resistance with pooling of blood volume in dependent body parts. Diagnosis is clinical, based on history of the circumstances of the event obtained from the patient and reliable eyewitness(es). In most patients, particularly under 45 years of age, the condition is benign and self-limiting, with an excellent prognosis, requiring little investigation beyond physical examination and electrocardiogram to exclude heart disease. Cardiac causes of syncope may require specific treatment.

scholarly journals Recurrent seizures in a young woman: when video-EEG diagnoses a cardiac cause: a case report

2020 ◽  
Vol 4 (5) ◽  
pp. 1-6
Author(s):  
Corentin Chaumont ◽  
Julie Bourilhon ◽  
Nathalie Chastan ◽  
Adrian Mirolo ◽  
Hélène Eltchaninoff ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
Loss Of Consciousness ◽  
Escape Rhythm ◽  
Cerebral Dysfunction ◽  
Psychosocial Consequences ◽  
Transient Loss ◽  
True Condition ◽  
Drug Resistant Epilepsy ◽  
Video Eeg

Abstract Background While transient loss of consciousness is a frequent presenting symptom, differential diagnosis between syncope and epilepsy can be challenging. Misdiagnosis of epilepsy leads to important psychosocial consequences and eliminates the opportunity to treat patient’s true condition. Case summary A 39-year-old woman presenting with recurrent seizures since her childhood was referred to neurological consultation. Electroencephalograms (EEGs) and magnetic resonance imaging previously performed were normal. A sleep-deprived video-EEG was performed and highlighted after 12 h of sleep deprivation a progressive dropping of the heart rate followed by a complete heart block without ventricular escape rhythm and asystole for about 30 s. Her EEG recording later showed diffuse slow waves traducing a global cerebral dysfunction and suffering. The diagnosis of vaso-vagal syncope with predominant cardioinhibitory response was made and a dual-chamber pacemaker with rate-drop response algorithm was implanted. After a 2 years of follow-up, the patient remained free of syncope. Discussion Patients presenting with loss of consciousness and convulsion are often diagnosed with epilepsy despite normal EEGs. In patients presenting with recurrent seizures with unclear diagnosis of epilepsy or in a situation of drug-resistant epilepsy, syncope diagnosis should always be considered and a risk stratification is necessary. The benefit of pacemaker implantation in patients with recurrent vaso-vagal syncope is still very controversial. Only patients presenting with spontaneous asystole should be considered for pacemaker implantation in case of recurrent vaso-vagal syncope.

Todd’s paresis following vasovagal syncope provoked by tilt-table testing

2020 ◽  
Vol 13 (6) ◽  
pp. e234402
Author(s):  
David Moloney ◽  
Laura Perez Pérez-Denia ◽  
Rose Anne Kenny
Keyword(s):  
Lower Limb ◽  
Vasovagal Syncope ◽  
Loss Of Consciousness ◽  
Left Hemiparesis ◽  
Tilt Table ◽  
History Of ◽  
Transient Loss ◽  
Mixed Pattern ◽  
Todd’S Paresis ◽  
The Brain

A 38-year-old woman presented with a history of recurrent episodes of transient loss of consciousness (TLOC) with seizure-like activity and post-TLOC left sided paresis. Electroencephalogram and MRI of the brain were normal, and events were not controlled by anti-convulsant therapy. Tilt testing produced reflex mixed pattern vasovagal syncope, with exact symptom reproduction, including bilateral upper and lower limb myoclonic movements and post-TLOC left hemiparesis that persisted for 27 min. A witness for the tilt event confirmed reproduction of patients ‘typical’ TLOC event. Syncope is the most frequent cause of TLOC. Myoclonic movements during syncope are not uncommon and can be misdiagnosed as epilepsy. It is rare to experience paresis after syncope, which in this case, lead to misdiagnosis and unnecessary anti-convulsant treatment.

Highlighted of Ramadan Fasting on Diabetes-Study of Complications, Biochemical Aspects and Anthropometry

2019 ◽  
Vol 26 (3) ◽  
pp. 227-234 ◽  
Author(s):  
Meriem Bencharif ◽  
Ibrahim Sersar ◽  
Maroua Bentaleb ◽  
Fatima Zohra Boutata ◽  
Youcef Benabbas
Keyword(s):  
Nutrition Education ◽  
Preventive Measures ◽  
Glucose Monitoring ◽  
Public Information ◽  
Blood Glucose Monitoring ◽  
Loss Of Consciousness ◽  
Ramadan Fasting ◽  
Balanced Diet ◽  
Before And After ◽  
And Gender

Abstract Background and aims: The diabetic exempted from fasting by religion, wishing or not to observe the fast, is exposed like any other during Ramadan to a change in lifestyle. The objective of this study was to highlight the effects of Ramadan fasting on diabetes. Material and methods: Multicentre study on 899 diabetics was carried to collect data on the behaviour of diabetics with regard to the fast of Ramadan, biochemicals and anthropometry parameters. Results. The sample consists of 541 diabetic fasters (DTMF) and 358 no fasters. The causes of interruption of fasting were: hypoglycemia (82.4%), dehydration (44.5%), hyperglycemia (12.6%), high blood pressure (13.7%), loss of consciousness (8.3%). The risk factors related to fasting for DTMF were the type of diabetes and gender. Discussion and modifications about dietary, blood glucose monitoring and nutritional education sessions showed a protective effect against the occurrence of hypo and hyperglycemia and loss of consciousness. Decreasing differences were noted for Hb1Ac, LDL and Total-Cholesterol between before and after Ramadan. The weight of DTMF decreased in post-Ramadan (p=0.0000). Conclusion. There is a need to consider regular preventive measures based on public information on the effects of diabetes related complications and the benefits of a balanced diet combined with regular physical activity in nutrition education sessions.

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