Malignant Neurocardiogenic Syncope Research Articles

Abstract 10047: A Case of Recurrent Miscarriages Due to Malignant Situational Cardioinhibitory Nerurocardiogenic Syncope Treated With Pacemaker Placement

Case Presentation: A 29- year-old G5A4 woman with history of seizure disorder presented with severe nausea and vomiting (N&V) with transient loss of consciousness with twitching motor activity at 7-weeks' gestation. She had no post-ictal state, but a brief period of nausea and lethargy with a rapid return to baseline. Her medical history only included a diagnosis of seizure disorder since childhood treated with different anti-epileptic agents. She reported 4 first-trimester abortions secondary to reported intractable recurrent seizures during pregnancy accompanied by significant morning sickness. Her physical examination, laboratory tests, brain CT, EEG, EKG, and a trans-thoracic echocardiogram were unremarkable. Levetiracetam was started. While monitored in telemetry she had an episode of complete heart block for 8-seconds with ventricular standstill triggered by a bout of severe N&V resulting in convulsive syncope. The diagnosis of situational cardioinhibitory malignant Neurocardiogenic Syncope (NS) was made. She underwent dual-chamber pacemaker implantation with complete resolution of her symptoms. After 6-months Levetiracetam was discontinued. Her pregnancy progressed to term delivering a healthy newborn. She remains asymptomatic 4 years after her pacemaker implantation. Discussion: Malignant NS is a type of neurally-mediated syncope that can lead to significant morbidity and occasional mortality. Situational syncope occurs when a vaso-vagal reflex occurs in response to a specific trigger, in the present case straining is associated with N&V and has not been described with miscarriages. In this case, the pronounced vagal response to N&V resulted in ventricular stand-still causing brain hypoperfusion and seizures, which are associated with miscarriage due to slower fetal heart rate, fetal hypoxia, fetal injury, placental hypoperfusion, placental abruption or trauma. To the best of our knowledge, this is the first case reported in the literature of recurrent miscarriages due to NS successfully treated with a pacemaker. Conclusions: Convulsive syncope can result in miscarriages and should remain in the differential diagnosis in patients presenting with suspected seizures associated with vaso-vagal triggers during pregnancy.

Malignant Neurocardiogenic Syncope: Recognition and Management within the Dental Operatory

Neurocardiogenic Syncope is a form of Dysautonomia which commonly occurs in children. It carries with it a potential for a range of responses from syncope to cardiac arrest. Because of these recurring events, this condition has a significant impact on their quality of life and causes them to alter daily routine living events. This report details the symptoms, pathophysiology, malignant vasovagal syncope, treatments, dental considerations, emergency management and highlights a case report featuring a history of cardiac arrest in a patient with multiple dental needs. The case outlines the efforts taken to avoid a repeat of complications from this condition and the difficulties encountered when disagreements exist among professionals. The perils of this condition are masked by their average appearance at presentation and emphasize the importance of an accurate medical history.

Prolonged Asystole during Head-Up Tilt Test in a Patient with Malignant Neurocardiogenic Syncope

A 27 year‐old man was taken to our emergency room after collapsing during a conference. The patient had a history of syncope twice since age 15. A marked sinus bradycardia and asystole were induced causing the patient to collapse when tested to stand up in the emergency room. Cardioinhibitory type neurocardiogenic syncope was considered to be the cause of the syncope. Therefore the patient was treated with oral disopyramide at a daily dose of 150 mg. Three weeks later, a head‐up tilt test was performed for evaluation of drug effectiveness. However, a prolonged asystole for 24 seconds due to sinus arrest without escape beat was induced 7 minutes after starting the tilt at 80 degrees. Although the tilt table was returned to the flat position immediately, it took an additional 30 seconds for complete recovery of the patient's consciousness.Malignant cardioinhibitory type neurocardiogenic syncope with a prolonged asystole such as was found in this patient has rarely been observed. Treatment options should be discussed if the patient refuses pacemaker implantation.

Prolonged Asystole during Head-Up Tilt Test in a Patient with Malignant Neurocardiogenic Syncope

Prolonged Asystole during Head-Up Tilt Test in a Patient with Malignant Neurocardiogenic Syncope

Cardioinhibitory syncope due to bloodphobia associated asystole

Neurocardiogenic syncope is not an uncommon occurrence in the general population and affects people across a wide range of age groups. Several sub-specialties are involved in the management of this phenomenon and quite often a multidisciplinary approach is needed for arriving at the final diagnosis and deciding on the optimal treatment for this condition. Often, a thorough history and physical examination will aid in narrowing the differential of syncope and, in the right setting, both passive and provocative testing can be complementary. Neurocardiogenic syncope with a malignant course is a serious entity and usually needs prompt identification of its underlying etiology. It has been generally attributed to a severe cardioinhibitory or vasodepressor mechanism and most cases required tailored therapy. We describe a case which has many of the elements described above — a multidisciplinary approach, malignant neurocardiogenic syncope with profound asystole from a cardioinhibitory response, simplistic bed-side provocative testing, and tailored therapy.

Reproducibility of tilt-table test result in patients with malignant neurocardiogenic syncope.

The indication for permanent pacemaker remains controversial in malignant neurocardiogenic syncope. A highly reproducible prolonged pause during a repeat head-up tilt-table testing may identify a subgroup of neurally mediated syncope with a prominent and consistent cardioinhibitory component. Seven patients (3 females) with a mean age of 30 years (23-44 years) were diagnosed to have malignant neurocardiogenic -syncope; all are classified according to the Vasovagal Syncope International Study as 2B type, with observed sinus pauses ranged from 3 s to 26 s of which only 1 demonstrated a reproducible sinus pause. No recurrence of syncope was clinically observed in patients during the follow-up period. Of 6 patients treated non--pharmacologically, one required a beta-blocker and none required a permanent pacemaker. Prolonged asystole manifest during head-up tilt-table testing is a poorly reproducible phenomenon and permanent pacemaker implantation in malignant neurocardiogenic syncope should not be a first line therapy.

19.8 Prevention of malignant neurocardiogenic syncope: Outcomes of the invasy study on CLS pacing

19.8 Prevention of malignant neurocardiogenic syncope: Outcomes of the invasy study on CLS pacing

19.8 Prevention of malignant neurocardiogenic syncope: Outcomes of the invasy study on CLS pacing

19.8 Prevention of malignant neurocardiogenic syncope: Outcomes of the invasy study on CLS pacing

19.8 Prevention of malignant neurocardiogenic syncope: Outcomes of the invasy study on CLS pacing

19.8 Prevention of malignant neurocardiogenic syncope: Outcomes of the invasy study on CLS pacing

Malignant neurocardiogenic syncope: Efficacy and safety of β-blocking treatment guided by head up tilt test

Malignant neurocardiogenic syncope: Efficacy and safety of β-blocking treatment guided by head up tilt test