Abordagem diagnóstica e terapêutica da síncope reflexa cardio‐inibitória – A complexidade de um tema controverso

Translated title of the contribution: Diagnostic and therapeutic approach to cardioinhibitory reflex syncope: A complex and controversial issue

Bruno M.L. Rocha, Rita V. Gomes, Gonçalo J.L. Cunha, Beatriz M.V. Silva, Rita Pocinho, Rui Morais, Inês Araújo, Cândida Fonseca

Research output: Contribution to journalReview article

Abstract

Syncope is defined as a transient loss of consciousness due to global cerebral hypoperfusion and is one of the leading causes of emergency department admission. The initial approach should focus on excluding non‐syncopal causes for loss of consciousness and risk stratification for cardiac cause, in order to ensure an appropriate etiological investigation and therapeutic approach. Vasovagal syncope (VVS), the most common type of syncope, should be assumed once other causes are excluded. Pathophysiologically, the vasovagal reflex is the result of a paradoxical autonomic response, leading to hypotension and/or bradycardia. VVS has not been shown to affect mortality, but morbidity may be considerable in those with recurrent syncopal episodes. The management of VVS includes both non‐pharmacological and pharmacological measures that act on various levels of the reflex arc that triggers the syncopal episode. However, most are of uncertain benefit given the scarcity of high‐quality supporting evidence. Pacemaker therapy may be considered in recurrent refractory cardioinhibitory reflex syncope, for which it is currently considered a robust intervention, as noted in the European guidelines. Non‐randomized and unblinded studies have shown a potential benefit of pacing in recurrent VVS, but double‐blinded randomized controlled trials have not consistently demonstrated positive results. We performed a comprehensive review of the current literature and recent advances in cardiac pacing and pacing algorithms in VVS, and discuss the diagnostic and therapeutic approach to the complex patient with recurrent VVS and reduced quality of life.

Original languagePortuguese
Pages (from-to)661-673
Number of pages13
JournalRevista Portuguesa de Cardiologia
Volume38
Issue number9
DOIs
Publication statusPublished - 1 Sep 2019

Fingerprint

Vasovagal Syncope
Syncope
Reflex
Unconsciousness
Therapeutics
Bradycardia
Hypotension
Hospital Emergency Service
Randomized Controlled Trials
Quality of Life
Pharmacology
Guidelines
Morbidity
Mortality

Keywords

  • Loss of consciousness
  • Pacemaker
  • Syncope
  • Vasovagal reflex

Cite this

Rocha, Bruno M.L. ; Gomes, Rita V. ; Cunha, Gonçalo J.L. ; Silva, Beatriz M.V. ; Pocinho, Rita ; Morais, Rui ; Araújo, Inês ; Fonseca, Cândida. / Abordagem diagnóstica e terapêutica da síncope reflexa cardio‐inibitória – A complexidade de um tema controverso. In: Revista Portuguesa de Cardiologia. 2019 ; Vol. 38, No. 9. pp. 661-673.
@article{89abfbb380f14aefb339c11281e34fe4,
title = "Abordagem diagn{\'o}stica e terap{\^e}utica da s{\'i}ncope reflexa cardio‐inibit{\'o}ria – A complexidade de um tema controverso",
abstract = "Syncope is defined as a transient loss of consciousness due to global cerebral hypoperfusion and is one of the leading causes of emergency department admission. The initial approach should focus on excluding non‐syncopal causes for loss of consciousness and risk stratification for cardiac cause, in order to ensure an appropriate etiological investigation and therapeutic approach. Vasovagal syncope (VVS), the most common type of syncope, should be assumed once other causes are excluded. Pathophysiologically, the vasovagal reflex is the result of a paradoxical autonomic response, leading to hypotension and/or bradycardia. VVS has not been shown to affect mortality, but morbidity may be considerable in those with recurrent syncopal episodes. The management of VVS includes both non‐pharmacological and pharmacological measures that act on various levels of the reflex arc that triggers the syncopal episode. However, most are of uncertain benefit given the scarcity of high‐quality supporting evidence. Pacemaker therapy may be considered in recurrent refractory cardioinhibitory reflex syncope, for which it is currently considered a robust intervention, as noted in the European guidelines. Non‐randomized and unblinded studies have shown a potential benefit of pacing in recurrent VVS, but double‐blinded randomized controlled trials have not consistently demonstrated positive results. We performed a comprehensive review of the current literature and recent advances in cardiac pacing and pacing algorithms in VVS, and discuss the diagnostic and therapeutic approach to the complex patient with recurrent VVS and reduced quality of life.",
keywords = "Loss of consciousness, Pacemaker, Syncope, Vasovagal reflex",
author = "Rocha, {Bruno M.L.} and Gomes, {Rita V.} and Cunha, {Gon{\cc}alo J.L.} and Silva, {Beatriz M.V.} and Rita Pocinho and Rui Morais and In{\^e}s Ara{\'u}jo and C{\^a}ndida Fonseca",
year = "2019",
month = "9",
day = "1",
doi = "10.1016/j.repc.2018.11.007",
language = "Portuguese",
volume = "38",
pages = "661--673",
journal = "Revista Portuguesa de Cardiologia",
issn = "0870-2551",
publisher = "Sociedade Portuguesa de Cardiologia",
number = "9",

}

Abordagem diagnóstica e terapêutica da síncope reflexa cardio‐inibitória – A complexidade de um tema controverso. / Rocha, Bruno M.L.; Gomes, Rita V.; Cunha, Gonçalo J.L.; Silva, Beatriz M.V.; Pocinho, Rita; Morais, Rui; Araújo, Inês; Fonseca, Cândida.

In: Revista Portuguesa de Cardiologia, Vol. 38, No. 9, 01.09.2019, p. 661-673.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Abordagem diagnóstica e terapêutica da síncope reflexa cardio‐inibitória – A complexidade de um tema controverso

AU - Rocha, Bruno M.L.

AU - Gomes, Rita V.

AU - Cunha, Gonçalo J.L.

AU - Silva, Beatriz M.V.

AU - Pocinho, Rita

AU - Morais, Rui

AU - Araújo, Inês

AU - Fonseca, Cândida

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Syncope is defined as a transient loss of consciousness due to global cerebral hypoperfusion and is one of the leading causes of emergency department admission. The initial approach should focus on excluding non‐syncopal causes for loss of consciousness and risk stratification for cardiac cause, in order to ensure an appropriate etiological investigation and therapeutic approach. Vasovagal syncope (VVS), the most common type of syncope, should be assumed once other causes are excluded. Pathophysiologically, the vasovagal reflex is the result of a paradoxical autonomic response, leading to hypotension and/or bradycardia. VVS has not been shown to affect mortality, but morbidity may be considerable in those with recurrent syncopal episodes. The management of VVS includes both non‐pharmacological and pharmacological measures that act on various levels of the reflex arc that triggers the syncopal episode. However, most are of uncertain benefit given the scarcity of high‐quality supporting evidence. Pacemaker therapy may be considered in recurrent refractory cardioinhibitory reflex syncope, for which it is currently considered a robust intervention, as noted in the European guidelines. Non‐randomized and unblinded studies have shown a potential benefit of pacing in recurrent VVS, but double‐blinded randomized controlled trials have not consistently demonstrated positive results. We performed a comprehensive review of the current literature and recent advances in cardiac pacing and pacing algorithms in VVS, and discuss the diagnostic and therapeutic approach to the complex patient with recurrent VVS and reduced quality of life.

AB - Syncope is defined as a transient loss of consciousness due to global cerebral hypoperfusion and is one of the leading causes of emergency department admission. The initial approach should focus on excluding non‐syncopal causes for loss of consciousness and risk stratification for cardiac cause, in order to ensure an appropriate etiological investigation and therapeutic approach. Vasovagal syncope (VVS), the most common type of syncope, should be assumed once other causes are excluded. Pathophysiologically, the vasovagal reflex is the result of a paradoxical autonomic response, leading to hypotension and/or bradycardia. VVS has not been shown to affect mortality, but morbidity may be considerable in those with recurrent syncopal episodes. The management of VVS includes both non‐pharmacological and pharmacological measures that act on various levels of the reflex arc that triggers the syncopal episode. However, most are of uncertain benefit given the scarcity of high‐quality supporting evidence. Pacemaker therapy may be considered in recurrent refractory cardioinhibitory reflex syncope, for which it is currently considered a robust intervention, as noted in the European guidelines. Non‐randomized and unblinded studies have shown a potential benefit of pacing in recurrent VVS, but double‐blinded randomized controlled trials have not consistently demonstrated positive results. We performed a comprehensive review of the current literature and recent advances in cardiac pacing and pacing algorithms in VVS, and discuss the diagnostic and therapeutic approach to the complex patient with recurrent VVS and reduced quality of life.

KW - Loss of consciousness

KW - Pacemaker

KW - Syncope

KW - Vasovagal reflex

UR - http://www.scopus.com/inward/record.url?scp=85076424884&partnerID=8YFLogxK

U2 - 10.1016/j.repc.2018.11.007

DO - 10.1016/j.repc.2018.11.007

M3 - Review article

VL - 38

SP - 661

EP - 673

JO - Revista Portuguesa de Cardiologia

JF - Revista Portuguesa de Cardiologia

SN - 0870-2551

IS - 9

ER -