Neurally mediated reflex syncope

References

Key articles

Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines, and the Heart Rhythm Society. Heart Rhythm. 2017 Aug;14(8):e155-217.Full text  Abstract

Brignole M, Moya A, de Lange FJ, et al; ESC Scientific Document Group. 2018 ESC guidelines for the diagnosis and management of syncope. Eur Heart J. 2018 Jun 1;39(21):1883-948.Full text  Abstract

Moya A, Brignole M, Menozzi C, et al; International Study on Syncope of Uncertain Etiology (ISSUE) Investigators. Mechanism of syncope in patients with isolated syncope and in patients with tilt-positive syncope. Circulation. 2001 Sep 11;104(11):1261-7.Full text  Abstract

Sandhu RK, Raj SR, Manlucu J, et al; Primary Writing Committee. Canadian Cardiovascular Society clinical practice update on the assessment and management of syncope. Can J Cardiol. 2020 Aug;36(8):1167-77.Full text  Abstract

Reed MJ, Newby DE, Coull AJ, et al. The ROSE (risk stratification of syncope in the emergency department) study. J Am Coll Cardiol. 2010 Feb 23;55(8):713-21.Full text  Abstract

Benditt DG, Ferguson DW, Grubb BP, et al. Tilt table testing for assessing syncope. American College of Cardiology. J Am Coll Cardiol. 1996 Jul;28(1):263-75. Abstract

Raviele A, Giada F, Menozzi C, et al; Vasovagal Syncope and Pacing Trial Investigators. 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 Oct;25(19):1741-8.Full text  Abstract

Reference articles

1. Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines, and the Heart Rhythm Society. Heart Rhythm. 2017 Aug;14(8):e155-217.Full text  Abstract

2. Brignole M, Moya A, de Lange FJ, et al; ESC Scientific Document Group. 2018 ESC guidelines for the diagnosis and management of syncope. Eur Heart J. 2018 Jun 1;39(21):1883-948.Full text  Abstract

3. Blanc J-J, Benditt DG. Syncope: definition, classification, and multiple potential causes. In: Benditt DG, Blanc J-J, Brignole M, et al, eds. The evaluation and treatment of syncope: a handbook for clinical practice. Elmsford, NY: Futura/Blackwell; 2003:3-10.

4. Kenny RA, Ingram A, Bayliss J, et al. Head-up tilt: a useful test for investigating unexplained syncope. Lancet. 1986 Jun 14;1(8494):1352-5. Abstract

5. Olshansky B, Poole JE, Johnson G, et al; SCD-HeFT Investigators. Syncope predicts the outcome of cardiomyopathy patients: analysis of the SCD-HeFT study. J Am Coll Cardiol. 2008 Apr 1;51(13):1277-82.Full text  Abstract

6. Prasad K, Williams L, Campbell R, et al. Episodic syncope in hypertrophic cardiomyopathy: evidence for inappropriate vasodilation. Heart. 2008 Oct;94(10):1312-7. Abstract

7. Moya A, Brignole M, Menozzi C, et al; International Study on Syncope of Uncertain Etiology (ISSUE) Investigators. Mechanism of syncope in patients with isolated syncope and in patients with tilt-positive syncope. Circulation. 2001 Sep 11;104(11):1261-7.Full text  Abstract

8. Thijs RD, Kruit MC, van Buchem MA, et al. Syncope in migraine: the population-based CAMERA study. Neurology. 2006 Apr 11;66(7):1034-7. Abstract

9. Alciati A, Shiffer D, Dipaola F, et al. Psychogenic pseudosyncope: clinical features, diagnosis and management. J Atr Fibrillation. 2020 Jun-Jul;13(1):2399.Full text  Abstract

10. Mathias CJ, Bannister R. Clinical features and evaluation of the primary chronic autonomic failure syndromes. In: Bannister R, Mathias CJ, eds. Autonomic failure: a textbook of clinical disorders of the autonomic nervous system. 4th ed. New York, NY: Oxford University Press; 1999:562.

11. Blanc JJ, L'Her C, Touiza A, et al. Prospective evaluation and outcome of patients admitted for syncope over a 1 year period. Eur Heart J. 2002 May;23(10):815-20.Full text  Abstract

12. Disertori M, Brignole M, Menozzi C, et al. Management of patients with syncope referred urgently to general hospitals. Europace. 2003 Jul;5(3):283-91.Full text  Abstract

13. Runser LA, Gauer RL, Houser A. Syncope: evaluation and differential diagnosis. Am Fam Physician. 2017 Mar 1;95(5):303-12.Full text  Abstract

14. Ganzeboom KS, Mairuhu G, Reitsma JB, et al. Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35-60 years. J Cardiovasc Electrophysiol. 2006 Nov;17(11):1172-6. Abstract

15. Ruwald MH, Hansen ML, Lamberts M, et al. The relation between age, sex, comorbidity, and pharmacotherapy and the risk of syncope: a Danish nationwide study. Europace. 2012 Oct;14(10):1506-14.Full text  Abstract

16. Saklani P, Krahn A, Klein G. Syncope. Circulation. 2013 Mar 26;127(12):1330-9.Full text  Abstract

17. Lipsitz LA, Wei JY, Rowe JW. Syncope in an elderly institutionalised population: prevalence, incidence, and associated risk. Q J Med. 1985 Apr;55(216):45-54. Abstract

18. Soteriades ES, Evans JC, Larson MG, et al. Incidence and prognosis of syncope. N Engl J Med. 2002 Sep 19;347(12):878-85.Full text  Abstract

19. Benditt DG, Brignole M. Syncope: is a diagnosis a diagnosis? J Am Coll Cardiol. 2003 Mar 5;41(5):791-4.Full text  Abstract

20. Van Lieshout JJ, Wieling W, Karemaker JM, et al. Syncope, cerebral perfusion, and oxygenation. J Appl Physiol. 2003 Mar;94(3):833-48.Full text  Abstract

21. Rowell LB. Cerebral and coronary circulations. In: Rowell LB, ed. Human cardiovascular control. New York, NY: Oxford University Press; 1993:117-36.

22. Brignole M, Menozzi C, Gianfranchi L, et al. Neurally mediated syncope detected by carotid sinus massage and head-up tilt test in sick sinus syndrome. Am J Cardiol. 1991 Oct 15;68(10):1032-6. Abstract

23. Sarasin FP, Louis-Simonet M, Carballo D, et al. Prospective evaluation of patients with syncope: a population-based study. Am J Med. 2001 Aug 15;111(3):177-84. Abstract

24. Farwell D, Sulke N. How do we diagnose syncope? J Cardiovasc Electrophysiol. 2002 Jan;13(1 Suppl):S9-13. Abstract

25. D'Ascenzo F, Biondi-Zoccai G, Reed MJ, et al. Incidence, etiology and predictors of adverse outcomes in 43,315 patients presenting to the Emergency Department with syncope: an international meta-analysis. Int J Cardiol. 2013 Jul 15;167(1):57-62.Full text  Abstract

26. Sandhu RK, Raj SR, Manlucu J, et al; Primary Writing Committee. Canadian Cardiovascular Society clinical practice update on the assessment and management of syncope. Can J Cardiol. 2020 Aug;36(8):1167-77.Full text  Abstract

27. Prandoni P, Lensing AW, Prins MH, et al; PESIT Investigators. Prevalence of pulmonary embolism among patients hospitalized for syncope. N Engl J Med. 2016 Oct 20;375(16):1524-31.Full text  Abstract

28. Quinn JV, Stiell IG, McDermott DA, et al. Derivation of the San Francisco Syncope Rule to predict patients with short-term serious outcomes. Ann Emerg Med. 2004 Feb;43(2):224-32. Abstract

29. Reed MJ, Newby DE, Coull AJ, et al. The ROSE (risk stratification of syncope in the emergency department) study. J Am Coll Cardiol. 2010 Feb 23;55(8):713-21.Full text  Abstract

30. National Institute for Health and Care Excellence. Transient loss of consciousness ('blackouts') in over 16s. Sep 2014 [internet publication].Full text

31. Benditt DG, Ferguson DW, Grubb BP, et al. Tilt table testing for assessing syncope. American College of Cardiology. J Am Coll Cardiol. 1996 Jul;28(1):263-75. Abstract

32. Almquist A, Goldenberg IF, Milstein S, et al. Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope. N Engl J Med. 1989 Feb 9;320(6):346-51. Abstract

33. Fitzpatrick AP, Theodorakis G, Vardas P, et al. Methodology of head-up tilt testing in patients with unexplained syncope. J Am Coll Cardiol. 1991 Jan;17(1):125-30. Abstract

34. Raviele A, Giada F, Menozzi C, et al; Vasovagal Syncope and Pacing Trial Investigators. 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 Oct;25(19):1741-8.Full text  Abstract

35. Kapoor WN, Smith MA, Miller NL. Upright tilt testing in evaluating syncope: a comprehensive literature review. Am J Med. 1994 Jul;97(1):78-88. Abstract

36. Morley CA, Sutton R. Carotid sinus syncope. Int J Cardiol. 1984 Sep;6(3):287-93. Abstract

37. Dandy WE. Glossopharyngeal neuralgia (tic douloureux): its diagnosis and treatment. Arch Surg. 1927 Aug;15(2):198-214.

38. Gottesman MH, Ibrahim B, Elfenbein AS, et al. Cardiac arrest caused by trigeminal neuralgia. Headache. 1996 Jun;36(6):392-4. Abstract

39. Thijs RD, Brignole M, Falup-Pecurariu C, et al. Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness: consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN). Auton Neurosci. 2021 Jul;233:102792.Full text  Abstract

40. Brignole M, Menozzi C, Moya A, et al; International Study on Syncope of Uncertain Etiology (ISSUE) Investigators. Mechanism of syncope in patients with bundle branch block and negative electrophysiological test. Circulation. 2001 Oct 23;104(17):2045-50.Full text  Abstract

41. Menozzi C, Brignole M, Garcia-Civera R, et al; International Study on Syncope of Uncertain Etiology (ISSUE) Investigators. Mechanism of syncope in patients with heart disease and negative electrophysiologic test. Circulation. 2002 Jun 11;105(23):2741-5.Full text  Abstract

42. Solari D, Maggi R, Oddone D, et al. Clinical context and outcome of carotid sinus syndrome diagnosed by means of the 'method of symptoms'. Europace. 2014 Jun;16(6):928-34.Full text  Abstract

43. Brignole M, Moya A, de Lange FJ, et al; ESC Scientific Document Group. Practical instructions for the 2018 ESC guidelines for the diagnosis and management of syncope. Eur Heart J. 2018 Jun 1;39(21):e43-80.Full text  Abstract

44. Flammang D, Church T, Waynberger M, et al. Can adenosine 5'-triphosphate be used to select treatment in severe vasovagal syndrome? Circulation. 1997 Aug 19;96(4):1201-8.Full text  Abstract

45. Flammang D, Chassing A, Donal E, et al. Reproducibility of the adenosine-5'-triphosphate test in vasovagal syndrome. J Cardiovasc Electrophysiol. 1998 Nov;9(11):1161-6. Abstract

46. Blanc JJ. Clinical laboratory testing: what is the role of tilt-table testing, active standing test, carotid massage, electrophysiological testing and ATP test in the syncope evaluation? Prog Cardiovasc Dis. 2013 Jan-Feb;55(4):418-24. Abstract

47. Benditt DG, Samniah N, Pham S, et al. Effect of cough on heart rate and blood pressure in patients with "cough syncope". Heart Rhythm. 2005 Aug;2(8):807-13. Abstract

48. Jacobus JR, Johannes BR, Catherine NB, et al. Drugs and pacemakers for vasovagal, carotid sinus and situational syncope. Cochrane Database Syst Rev. 2011 Oct 5;(10):CD004194.Full text  Abstract

49. Izcovich A, González Malla C, Manzotti M, et al. Midodrine for orthostatic hypotension and recurrent reflex syncope: a systematic review. Neurology. 2014 Sep 23;83(13):1170-7. Abstract

50. Krediet CT, van Dijk N, Linzer M, et al. Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation. 2002 Sep 24;106(13):1684-9.Full text  Abstract

51. Brignole M, Croci F, Menozzi C, et al. Isometric arm counter-pressure maneuvers to abort impending vasovagal syncope. J Am Coll Cardiol. 2002 Dec 4;40(11):2053-9.Full text  Abstract

52. van Dijk N, Quartieri F, Blanc JJ, et al; PC-Trial Investigators. Effectiveness of physical counterpressure maneuvers in preventing vasovagal syncope: the Physical Counterpressure Manoeuvres Trial (PC-Trial). J Am Coll Cardiol. 2006 Oct 17;48(8):1652-7.Full text  Abstract

53. Ector H, Reybrouck T, Heidbüchel H, et al. Tilt training: a new treatment for recurrent neurocardiogenic syncope and severe orthostatic intolerance. Pacing Clin Electrophysiol. 1998 Jan;21(1 Pt 2):193-6. Abstract

54. 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 Oct 26;100(17):1798-801.Full text  Abstract

55. Reybrouck T, Heidbüchel H, Van De Werf F, et al. Long-term follow-up results of tilt training therapy in patients with recurrent neurocardiogenic syncope. Pacing Clin Electrophysiol. 2002 Oct;25(10):1441-6. Abstract

56. Kinay O, Yazici M, Nazli C, et al. Tilt training for recurrent neurocardiogenic syncope: effectiveness, patient compliance, and scheduling the frequency of training sessions. Jpn Heart J. 2004 Sep;45(5):833-43. Abstract

57. On YK, Park J, Huh J, et al. Is home orthostatic self-training effective in preventing neurally mediated syncope? Pacing Clin Electrophysiol. 2007 May;30(5):638-43. Abstract

58. Gurevitz O, Barsheshet A, Bar-Lev D, et al. Tilt training: does it have a role in preventing vasovagal syncope? Pacing Clin Electrophysiol. 2007 Dec;30(12):1499-505. Abstract

59. Scott WA, Pongiglione G, Bromberg BI, et al. Randomized comparison of atenolol and fludrocortisone acetate in the treatment of pediatric neurally mediated syncope. Am J Cardiol. 1995 Aug 15;76(5):400-2. Abstract

60. Salim MA, Di Sessa TG. Effectiveness of fludrocortisone and salt in preventing syncope recurrence in children: a double-blind, placebo-controlled, randomized trial. J Am Coll Cardiol. 2005 Feb 15;45(4):484-8.Full text  Abstract

61. Sheldon R, Morillo CA, Krahn A, et al. A randomized clinical trial of fludrocortisone for the prevention of vasovagal syncope (POST II). Paper presented at: Canadian Cardiovascular Congress 2011. Vancouver, Canada. Abstract 903. Can J Cardiol. 2011 Sep 1;27(suppl 5):S335-6.Full text

62. Mahanonda N, Bhuripanyo K, Kangkagate C, et al. Randomized double-blind, placebo-controlled trial of oral atenolol in patients with unexplained syncope and positive upright tilt table test results. Am Heart J. 1995 Dec;130(6):1250-3. Abstract

63. Sheldon R, Connolly S, Rose S, et al; POST Investigators. Prevention of Syncope Trial (POST): a randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope. Circulation. 2006 Mar 7;113(9):1164-70.Full text  Abstract

64. Jankovic J, Gilden JL, Hiner BC, et al. Neurogenic orthostatic hypotension: a double-blind, placebo-controlled study with midodrine. Am J Med. 1993 Jul;95(1):38-48. Abstract

65. Ward CR, Gray JC, Gilroy JJ, et al. Midodrine: a role in the management of neurocardiogenic syncope. Heart. 1998 Jan;79(1):45-9.Full text  Abstract

66. Perez-Lugones A, Schweikert R, Pavia S, et al. Usefulness of midodrine in patients with severely symptomatic neurocardiogenic syncope: a randomized control study. J Cardiovasc Electrophysiol. 2001 Aug;12(8):935-8. Abstract

67. Sheldon R, Faris P, Tang A, et al; POST 4 investigators. Midodrine for the prevention of vasovagal syncope: a randomized clinical trial. Ann Intern Med. 2021 Oct;174(10):1349-56. Abstract

68. Grubb BP, Kosinski D, Mouhaffel A, et al. A. The use of methylphenidate in the treatment of refractory neurocardiogenic syncope. Pacing Clin Electrophysiol. 1996 May;19(5):836-40. Abstract

69. Sutton R, Brignole M, Menozzi C, et al; the Vasovagal Syncope International Study (VASIS) Investigators. Dual-chamber pacing in the treatment of neurally mediated tilt-positive cardioinhibitory syncope. Pacemaker versus no therapy: a multicenter randomized study. Circulation. 2000 Jul 18;102(3):294-9.Full text  Abstract

70. Grubb BP, Wolfe DA, Samoil D, et al. Usefulness of fluoxetine hydrochloride for prevention of resistant upright tilt induced syncope. Pacing Clin Electrophysiol. 1993 Mar;16(3 Pt 1):458-64. Abstract

71. Ammirati F, Colivicchi F, Santini M; Syncope Diagnosis and Treatment Study Investigators. Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope: a multicenter, randomized, controlled trial. Circulation. 2001 Jul 3;104(1):52-7.Full text  Abstract

72. Connolly SJ, Sheldon R, Roberts RS, 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 Jan;33(1):16-20.Full text  Abstract

73. Connolly SJ, Sheldon R, Thorpe KE, et al; VPS II Investigators. Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope. Second Vasovagal Pacemaker Study (VPS II): a randomized trial. JAMA. 2003 May 7;289(17):2224-9.Full text  Abstract

74. Russo V, Rago A, Papa AA, et al. The effect of dual-chamber closed-loop stimulation on syncope recurrence in healthy patients with tilt-induced vasovagal cardioinhibitory syncope: a prospective, randomised, single-blind, crossover study. Heart. 2013 Nov;99(21):1609-13. Abstract

75. Sun W, Zheng L, Qiao Y, et al. Catheter ablation as a treatment for vasovagal syncope: long-term outcome of endocardial autonomic modification of the left atrium. J Am Heart Assoc. 2016 Jul 8;5(7):e003471.Full text  Abstract

76. Sahota IS, Maxey C, Pournazari P, et al. Clusters, gaps, and randomness: vasovagal syncope recurrence patterns. JACC Clin Electrophysiol. 2017 Sep;3(9):1046-53.Full text  Abstract

77. Pournazari P, Sahota I, Sheldon R. High remission rates in vasovagal syncope: systematic review and meta-analysis of observational and randomized studies. JACC Clin Electrophysiol. 2017 Apr;3(4):384-92.Full text  Abstract

78. Solbiati M, Casazza G, Dipaola F, et al. Syncope recurrence and mortality: a systematic review. Europace. 2015 Feb;17(2):300-8.Full text  Abstract

79. Jorge JG, Raj SR, Teixeira PS, et al. Likelihood of injury due to vasovagal syncope: a systematic review and meta-analysis. Europace. 2021 Jul 18;23(7):1092-9. Abstract

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