Abstract
Neurocardiogenic syncope is the most frequent cause of syncope in the general population. Many years have been spent on determining an effective treatment for this condition. Conventional treatment usually follows a tiered approach for neurocardiogenic syncope, as follows: first, lifestyle modification, including increased fluid intake and the introduction of physical counterpressure maneuvers, is tried; then the use of targeted pharmacologic therapy, particularly agents that support blood pressure or that drive blood pressure is attempted; and, finally, pacemaker implantation in patients with a predominant cardioinhibitory component to their syncopal episodes is performed. More recently, autonomic modulation with cardiac ganglion ablation has emerged as a promising treatment modality for patients refractory to traditional approaches. In this review, we sought to summarize the existing therapies for neurocardiogenic syncope and explore the latest research on new modalities of treatment.
Highlights
Neurocardiogenic syncope (NCS), known as vasovagal syncope, is one of the most frequent causes of syncope in the general population
There is an element of predisposition that makes the onset of NCS more likely for some patients when they are exposed to common triggers
During an average follow-up period of 14 months, recurrent syncope was found to be significantly reduced with the use of Physical counterpressure maneuvers (PCMs)
Summary
Neurocardiogenic syncope (NCS), known as vasovagal syncope, is one of the most frequent causes of syncope in the general population. The VASIS study[34] randomized patients with recurrent syncope to receive a pacemaker (DDI with hysteresis) versus no therapy These patients were more highly selected than those in the previous study; a documented cardioinhibitory response, VASIS class IIa or IIb, was required on a prolonged HUT protocol for patients to be included in the trial. ISSUE-3 addressed this limitation by again selecting only patients with asystole on ILR and randomizing them to receive a pacemaker with active pacing (DDD with rate-drop response) or sensing only (ODO).[40] a 57% relative risk reduction was seen in the pacing group versus in the sensing group (p < 0.005), confirming that, in properly selected patients, dual-chamber pacing can reduce the recurrence of syncope, even accounting for the placebo effect. Several other case reports and case series have suggested a beneficial effect of cardiac ganglion ablation, but it is unclear how long these effects last and what method of
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: The Journal of innovations in cardiac rhythm management
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
