Cardiovascular Autonomic Dysfunction Is the Most Common Cause of Syncope in Paced Patients
Cardiovascular Autonomic Dysfunction Is the Most Common Cause of Syncope in Paced Patients
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DOI：
10.3389/fcvm.2019.00154
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发表时间：
2019-10-25
影响因子：
3.6
通讯作者：
Hamrefors, Viktor
中科院分区：
文献类型：
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作者：
Yasa, Ekrem;Ricci, Fabrizio;Hamrefors, Viktor
引言：起搏患者的晕厥和立位不耐受是一种常见的临床难题。因此，我们的目的是确定晕厥的病因和/或起搏患者的立位不耐受症状。研究方法：在1,705例不明原因晕厥和/或立位不耐受的患者中，通过心血管自主神经试验（包括Valsalva动作、主动站立、颈动脉窦按摩和倾斜试验）进行了研究，其中39例患者（2.3%;年龄65.6岁; 39%女性）植入了心脏植入式电子设备（CIED）。我们探讨了过去的病史，在心血管自主神经测试中发现的诊断，以及进一步的临床检查，如果初始评估为阴性。结果：39例患者中有36例在心血管自主神经试验中确定了病因。直立性低血压（n = 16; 41%）和血管迷走性晕厥（n = 12; 31%）是最常见的诊断。无起搏器功能障碍病例。最初的起搏适应症遵循指南（16例病窦综合征，16例房室传导阻滞，5例房颤伴心动过缓）。39例患者中有22例（56%）在初始CIED植入前发生晕厥。其中7名患者（32%）诊断为直立性低血压，9名患者（41%）诊断为血管迷走性晕厥。在最初CIED植入前未发生晕厥的17例患者中，9例患者（53%）被诊断为直立性低血压，3例患者（18%）被诊断为血管迷走性晕厥。在39名患者中，2名患者植入了心律转复器，以治疗晕厥发作后诊断的恶性室性心律失常。结论：心血管自主神经试验揭示了大多数起搏患者晕厥和/或立位不耐受的病因。最常见的诊断是体位性低血压（40%），其次是血管迷走性晕厥（30%），而没有起搏器功能障碍的病例。我们的研究结果强调了一个完整的诊断工作的重要性，包括心血管自主神经功能测试，在起搏的患者，目前与晕厥和/或直立不耐受。
Introduction: Syncope and orthostatic intolerance in paced patients constitute a common clinical dilemma. We, thus, aimed to determine the etiology of syncope and/or symptoms of orthostatic intolerance in paced patients. Methods: Among 1,705 patients with unexplained syncope and/or orthostatic intolerance that were investigated by cardiovascular autonomic tests, including Valsalva maneuver, active standing, carotid sinus massage, and tilt-testing, 39 patients (2.3%; age 65.6 years; 39% women) had a cardiac implantable electronic device (CIED). We explored past medical history, diagnoses found during cardiovascular autonomic tests, and the further clinical workup, in case of negative initial evaluation. Results: An etiology was identified during cardiovascular autonomic tests in 36 of the 39 patients. Orthostatic hypotension (n = 16; 41%) and vasovagal syncope (n = 12; 31%) were the most common diagnoses. There were no cases of pacemaker dysfunction. The original pacing indications followed guidelines (sick-sinus-syndrome in 16, atrioventricular block in 16, atrial fibrillation with bradycardia in five). Twenty-two of the 39 patients (56%) had experienced syncope prior to the original CIED implantation. Orthostatic hypotension was diagnosed in seven (32%) and vasovagal syncope in nine (41%) of these patients. Of the 17 patients that had not experienced syncope prior to the original CIED implantation, nine patients (53%) were diagnosed with orthostatic hypotension and vasovagal syncope was diagnosed in three (18%). Of the 39 patients, two had implantable cardioverter-defibrillators to treat malignant ventricular arrhythmias diagnosed after syncopal episodes. Conclusion: Cardiovascular autonomic tests reveal the etiology of syncope and/or orthostatic intolerance in the majority of paced patients. The most common diagnosis was orthostatic hypotension (40%) followed by vasovagal syncope (30%), whereas there were no cases of pacemaker dysfunction. Our results emphasize the importance of a complete diagnostic work-up, including cardiovascular autonomic tests, in paced patients that present with syncope and/or orthostatic intolerance.