Occurrence Of Syncope Research Articles

Procedural and Intermediate-term Results of the Electroanatomical-guided Cardioneuroablation for the Treatment of Supra-Hisian Second- or Advanced-degree Atrioventricular Block: the PIRECNA multicentre registry.

Prior case series showed promising results for cardioneuroablation in patients with vagally induced atrioventricular blocks (VAVBs). We aimed to examine the acute procedural characteristics and intermediate-term outcomes of electroanatomical-guided cardioneuroablation (EACNA) in patients with VAVB. This international multicentre retrospective registry included data collected from 20 centres. Patients presenting with symptomatic paroxysmal or persistent VAVB were included in the study. All patients underwent EACNA. Procedural success was defined by the acute reversal of atrioventricular blocks (AVBs) and complete abolition of atropine response. The primary outcome was occurrence of syncope and daytime second- or advanced-degree AVB on serial prolonged electrocardiogram monitoring during follow-up. A total of 130 patients underwent EACNA. Acute procedural success was achieved in 96.2% of the cases. During a median follow-up of 300 days (150, 496), the primary outcome occurred in 17/125 (14%) cases with acute procedural success (recurrence of AVB in 9 and new syncope in 8 cases). Operator experience and use of extracardiac vagal stimulation were similar for patients with and without primary outcomes. A history of atrial fibrillation, hypertension, and coronary artery disease was associated with a higher primary outcome occurrence. Only four patients with primary outcome required pacemaker placement during follow-up. This is the largest multicentre study demonstrating the feasibility of EACNA with encouraging intermediate-term outcomes in selected patients with VAVB. Studies investigating the effect on burden of daytime symptoms caused by the AVB are required to confirm these findings.

Pengaruh Pendidikan Kesehatan Dengan Petode Demonstrasi Terhadap Keterampilan Siswa PMR Dalam Tindakan Pertolongan Pertama Pada Syncope Di MAN Model Manado

Fainting or syncope is a condition where a person loses consciousness due to decreased blood flow to the brain. The occurrence of syncope in students at school can occur at any time. Therefore all students should be able to master first aid, at school Students must be able to pelrtollolngan pelrtama when syncope occurs quickly and quickly, even if the meldis assistance is only basic and belrbasis keldolktelran science known to many people.The purpose of this study was to determine the Effect of Health Education with Demonstration Methods on the Skills of PMR Students in First Aid Actions in Syncope at Man Model Manado. This research is a Pre-experiment design with One Group pretest-postest design. The sampling technique is total sampling with 30 respondents. Data collection uses an observation sheet. Analyzed with Mc Stastistic test. Nemar statistical test. From the Results: Mc.Nemar statistical test shows that there is a significant effect between health education with demonstration methods on the skills of PMR students in first aid actions in syncope at Man Model Manado. (p)= 0.000: α = 0.05. Conclusion: in this study there is an effect of Health Education with Demonstration Method on the Skills of PMR Students in First Aid Action on Syncope at Man Model Manado. This research is expected to be a reference for health and education installations in an effort to provide the influence of health education with demonstration methods on student skills in first aid actions in syncope.

Overview of Long-Term Outcome in Adults with Systemic Right Ventricle and Transposition of the Great Arteries: A Review.

The population of patients with a systemic right ventricle (sRV) in biventricular circulation includes those who have undergone an atrial switch operation for destro-transposition of the great arteries (d-TGA) and those with congenitally corrected transposition of the great arteries (ccTGA). Despite the life expectancy of these patients is significantly increased, the long-term prognosis remains suboptimal due to late complications such as heart failure, arrhythmias, and premature death. These patients, therefore, need a close follow-up to early identify predictive factors of adverse outcomes and to implement all preventive therapeutic strategies. This review analyzes the late complications of adult patients with an sRV and TGA and clarifies which are risk factors for adverse prognosis and which are the therapeutic strategies that improve the long-term outcomes. For prognostic purposes, it is necessary to monitor sRV size and function, the tricuspid valve regurgitation, the functional class, the occurrence of syncope, the QRS duration, N-terminal pro B-type natriuretic peptide levels, and the development of arrhythmias. Furthermore, pregnancy should be discouraged in women with risk factors. Tricuspid valve replacement/repair, biventricular pacing, and implantable cardioverter defibrillator are the most important therapeutic strategies that have been shown, when used correctly, to improve long-term outcomes.

Isolated PR prolongation in patients undergoing transcatheter aortic valve implantation

Abstract Funding Acknowledgements Type of funding sources: None. Background New conduction disturbances are common complications following transcatheter aortic valve implantation (TAVI). The last ESC guidelines recommended electrophysiological study (EPS) or long-term monitoring for patients with new LBBB above 150 ms or one that is associated with PR prolongation (IIa indication). For patients with preexisting conduction abnormality and further PR or QRS prolongation EPS or long-term monitoring are also recommended but with a IIb recommendation. The data regarding the prognosis and management of patients with isolated PR prolongation is limited. Purpose Evaluate the need for permanant pacmaker implantation, occurance of syncope and mortality during the 1st year following Transcatheter aortic valve implantation Methods All patients undergoing TAVI at Shaare Zedek Medical Center were retrospectively reviewed. All patients underwent at least 1 ECG prior and daily post the procedure. Patients with isolated PR prolongation > 20 ms compared to baseline ECG were included. While patients with preexisting permanent pacemaker (PPM), complete AV block or any peri or post procedural QRS widening > 20 ms were excluded. Patient were followed for 1 year for the occurrence of syncope, PPM or death. Results Excluding patients with preprocedural PPM, 1028 patients were reviewed. Compared to baseline ECG, 124 (12%) patients had isolated PR prolongation, of whom 88 (71%) and 36 (29%) had baseline narrow and wide QRS respectively. During follow-up none of these 88 patients with baseline narrow QRS required in hospital PPM, while only 2 patients with baseline wide QRS required in hospital PPM. During 1 year follow-up, 6 patients (4.8%) died and no one had syncopal episode or need for PPM. Conclusion Post TAVI, isolated new PR prolongation is not associated with an adverse outcome including syncope or progression to complete heart block and need for PPM at 1 year post the procedure. These finding may be considered when evaluating these patients post the procedure.

Effectiveness of Leg Raise and Leg Fold Maneuver to Prevent Syncope During Extraction of Teeth: A Pilot Study.

Objectives The primary objective of this study is to evaluate the effectiveness of leg raise and leg fold maneuvers to prevent syncope during extraction procedures. Methods This study included 30 patients with a previous history of syncope and dental anxiety. Patients were randomly divided into two groups consisting of 15 patients each. Group I (test group) patients were educated about a few physical maneuvers, and instructions were given preoperatively about when to perform them. Group II (control group) underwent extraction conventionally. The blood pressure, saturation, pulse rate, and clinical signs and symptoms of the patients were assessed preoperatively, intraoperatively, and postoperatively. Informed consent was obtained from all the patients. Results There is a significant difference between the control and study groups in terms of the occurrence of syncope and patient comfort. This indicates that the leg raise and leg fold maneuvers reducethe occurrence of syncope during extraction. No participant in the test group experienced syncope post-treatment, while five subjects (33.3%)experienced syncope in the control group. Conclusion Physical counterpressure maneuvers are a risk-free, effective, and low-cost treatment method in patients with vasovagal syncope.Leg raise and leg fold maneuversimproved the hemodynamics of the patients.

Syncope in ICD recipients: a single centre experience.

There is little evidence of the impact of syncope in implantable cardioverter-defibrillator (ICD) patients in routine community hospital care. This single-centre retrospective study sought to evaluate the incidence and prognostic significance of syncope in consecutive ICD patients. Data were collected on consecutive patients undergoing first ICD implantation between January 2009 and December 2019. The primary endpoints were the first occurrence of all-cause syncope, all-cause mortality, and all-cause hospitalization. Multivariate Cox proportional hazard models were used to identify risk factors associated with syncope and to analyse the subsequent risk of mortality and hospitalization. 1003 patients (58% primary prevention) were included in the final analysis. During a mean follow-up of 1519 ± 1055 days, 106 (10.6%) experienced syncope, 304 died (30.3%), and 477 (47.5%) were hospitalized for any cause. In an analysis adjusted for baseline variables, the first occurrence of syncope was associated with a significantly increased risk of mortality (HR 2.82, P < 0.001) and the first occurrence of hospitalization (HR 2.46, P = 0.002). Syncope in ICD recipients is common and associated with a poor prognosis irrespective of baseline variables and ICD programming. The occurrence of syncope is associated with a significant increase in the risk of mortality and hospitalization.

207 RE-DEFINING ARRHYTHMOGENIC CARDIOMYOPATHY: CHARACTERIZATION AND LONG-TERM PROGNOSTIC IMPLICATIONS

Abstract Background Arrhythmogenic dilated cardiomyopathy (AR-DCM) combines phenotypical aspects of dilated cardiomyopathy (DCM) and risk of sudden cardiac death (SCD), typical of the arrhythmogenic form (ACM). However, AR-DCM is often ambiguously defined leaving clinicians uncertain on how to identify these high-risk patients. The aims of the study were to re-define AR-DCM based on outcome related arrhythmic markers and to test the usefulness of the novel AR-DCM definition in identifying arrhythmogenic genotypes (i.e., LMNA, FLNC, RBM20, and desmosomal genes). Materials and methods Consecutive DCM patients with genetic evaluation and Holter ECG monitoring or telemetry in two referral institution were analyzed. The arrhythmic markers tested to define AR-DCM were: SCD or major ventricular arrhythmias (MVA), unexplained syncope, rapid nonsustained ventricular tachycardia (nsTV), ≥1000 premature ventricular contractions/24 hours, or ≥50 ventricular couplets/24 hours. Patients were labeled as Early AR-DCM if criteria were met within 12 months from enrolment. The primary endpoint was a composite of SCD/MVA; the secondary endpoint was a composite of all-cause mortality/heart transplant/LVAD implantation (D/HTx/LVAD). Results Among the 743 DCM patients included, 290 had disease-related variants (39%), 94 (30%) of these carried arrhythmogenic genotype. Early AR-DCM was identified in 429 (58%) patients. During a median follow-up of 7.0 [2.2-13.8] years, among arrhythmic markers the occurrence of syncope and/or nsVT within 12 months from enrolment were the only arrhythmic markers independently associated with SCD/MVA (Figure), while the occurrence of early MVA and/or nsTV emerged as the strongest long-term predictors of D/ HTx/LVAD. Family history of MVA was also independently associated with primary and secondary endpoints, and together with MVA, nsTV or unexplained syncope increased the agreement between AR-DCM and arrhythmogenic genotypes in 1 out 2 patients. Conclusions A combination of early (i.e., within 1 year from diagnosis) MVA or nsVT or unexplained syncope might be proposed as a clinically useful new definition of AR-DCM, especially if associated to family history of MVA. This definition in fact allows clinicians to anticipates worse long-term arrhythmic and global outcomes, and to accurately identify malignant arrhythmogenic genotypes.

Abstract 15379: Syncope and Pre-Syncope on the Exercise Test

Background: Data on the occurrence of syncope and presyncope with hemodynamic instability during graded exercise test (GXT) are limited. Methods: We reviewed the Mayo Integrated Stress Center database for non-imaging GXTs performed between January 2006 and December 2010 and registered syncopic/presyncopic episodes. Electronic medical records were reviewed for clinical information, outcomes, and mortality. SAS was used to provide background statistics. Results: During the study period, a total of 40,715 GXTs were performed on 33,885 unique patients, including 16,306 (40.0%) GXTs on patients with known cardiovascular disease (CVD). High risk for cardiac syncope is defined as prior cardiac arrest/ventricular tachycardia, ischemic cardiomyopathy, implanted defibrillator, history of atrial fibrillation, sotalol, amiodarone, LQTS, HOCM, aortic stenosis was identified in 3263 patients (6.0%), while risk factors for non-cardiac syncope (POTS, history of dizziness/spells/syncope, rest SBP &lt; 100 mmHg, age ≥ 80 years, female age &lt; 30 years, beta blocker use) were found in 15,925 patients (39.1%). Despite the presence of so many patients at risk, only 8 episodes of syncope occurred (0.020% per test; 0.023% per individual patient). Another 5 episodes of near-syncope with documented hypotension were aborted by the quick action of the testing staff (0.012% per test; 0.015% per individual patient). Only 1 patient (a 71yo M with severeCAD) required electrical cardioversion for ventricular fibrillation. None of the other patients, including all 6 women, presented with tachyarrhythmias. There were no deaths and no significant musculoskeletal trauma. Conclusion: Despite many patients with risk factors for cardiac and non-cardiac syncope in the cohort, syncope, and near-syncope with hemodynamic instability were very rare findings on guideline-directed GXTs.

Association between HV interval and electrocardiographic findings in individuals with syncope and left bundle branch block

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The occurrence of syncope is associated with increased mortality in patients with left bundle branch block (LBBB). Among syncope risk scores, it is consensual that electrocardiographic (ECG) abnormalities and the presence of underlying cardiac disease are prominent factors. However, there is no further investigation directed towards this population and there is few that could add to clinical judgement in such cases, until electrophysiological study (EPS) is performed. The method’s modest sensitivity limits its practical usage in spite of current literature recommendation. Therefore, identifying those patients more prone to serious events is of clinical significance. Objectives and methods This was a cross-sectional study of patients with syncope and LBBB undergoing EP study in a tertiary hospital, which aimed to assess the relation between ECG parameters and prolonged HV interval on EPS. Results Ninety-four consecutive patients were eligible for the final analysis. Mean age was 63.1 ± 11.9 years (68.1% male). As for main comorbidities, the prevalence of smoking was 39.3%, hypertension 84%, diabetes mellitus 29.7%, coronary artery disease 28.7% and reduced left ventricle ejection fraction (LVEF) (≤ 40%) 48.9%. In the univariable analysis, LVEF ≤ 40% appeared to be somewhat important but this was not confirmed upon logistic regression. QRS duration ≥ 165 ms (OR 7.79; p = 0.0005) and PR interval ≥ 220 ms (OR 7.10; p = 0.003) were independent predictors for HV interval ≥ 70 ms. For each 10 ms increase in QRS and PR duration, the odds of HV interval ≥ 70 ms enhanced by 39.8% and 27.1%, respectively. For the subgroup presented with such outcome, mean QRS was 170.88 ± 26.81 ms, significantly larger than the patients with HV interval &amp;lt; 70 ms. When combined, QRS ≥ 165 ms and PR interval ≥ 220 ms had an accuracy of 80% to predict an HV interval ≥ 70 ms in the EPS. Other analyzed data were not systematically associated with the evaluated outcome. Conclusion In patients with syncope and LBBB, prolonged QRS and PR interval were independent predictors of increased HV interval on EP study. Larger studies are needed to confirm these findings.

Impact Of Left Atrial Volume Index On Syncope In Patients With Hypertrophic Cardiomyopathy

Introduction Syncope commonly occurs in hypertrophic cardiomyopathy patients (HCM), usually without warning or prodrome and is associated with high risk for sudden death. Moreover, the exact mechanism of syncope cannot be identified making it difficult to predict which patients are at greatest risk for syncope. Prior studies have shown left atrial size to be associated with sudden death with markers of left atrial (LA) remodeling seen in advanced stages of HCM. However, it is unclear if LA structural changes correlate with incidence of syncope. Our aim was to evaluate if there is a correlation between left atrial volume index (LAVI) and occurrence of syncope in HCM patients. Methods This was a retrospective study of 123 HCM patients identified at our institution from 2016-2019. Diagnosis of syncope was identified by chart review. Left atrial volume index was determined by tracing the LA endocardial border in both the apical and four and two chamber view by two-dimensional echocardiography. HCM subtypes were defined as obstructive (presence of systolic anterior motion of the mitral valve—SAM), and non-obstructive (apical variant). Results Of 123 patients, 29 (23.6%) had syncope: 25 of the 100 SAM subjects and 4 of the 23 non-obstructive subjects. No difference in age, gender, or BMI was found between those with syncope and without syncope. LAVI showed a correlation with syncope in HCM patients (p< 0.05). In patients with a diagnosis of syncope, mean LAVI was larger compared to those without history of syncope (43.8±12.6 mL/m2 vs. 37.7±14.3 mL/m2). Each 1 mL/m2 increase in LAVI corresponded to a 1.03 OR risk for syncope. ROC analysis showed a LAVI threshold of 31.8mL/m2 for predicting syncope in all HCM (sensitivity 89.7%, specificity 40.4%) (Figure 1). Conclusion Syncope showed a strong correlation in those with larger LAVI with incremental risk of syncope for each 1 mL/m2 added to LAVI size. Our findings suggest LAVI may have utility as a marker to stratify HCM patients at risk for syncope. Further studies in HCM patients are needed to assess the impact of changes in LAVI size over time on cardiovascular outcomes. Syncope commonly occurs in hypertrophic cardiomyopathy patients (HCM), usually without warning or prodrome and is associated with high risk for sudden death. Moreover, the exact mechanism of syncope cannot be identified making it difficult to predict which patients are at greatest risk for syncope. Prior studies have shown left atrial size to be associated with sudden death with markers of left atrial (LA) remodeling seen in advanced stages of HCM. However, it is unclear if LA structural changes correlate with incidence of syncope. Our aim was to evaluate if there is a correlation between left atrial volume index (LAVI) and occurrence of syncope in HCM patients. This was a retrospective study of 123 HCM patients identified at our institution from 2016-2019. Diagnosis of syncope was identified by chart review. Left atrial volume index was determined by tracing the LA endocardial border in both the apical and four and two chamber view by two-dimensional echocardiography. HCM subtypes were defined as obstructive (presence of systolic anterior motion of the mitral valve—SAM), and non-obstructive (apical variant). Of 123 patients, 29 (23.6%) had syncope: 25 of the 100 SAM subjects and 4 of the 23 non-obstructive subjects. No difference in age, gender, or BMI was found between those with syncope and without syncope. LAVI showed a correlation with syncope in HCM patients (p< 0.05). In patients with a diagnosis of syncope, mean LAVI was larger compared to those without history of syncope (43.8±12.6 mL/m2 vs. 37.7±14.3 mL/m2). Each 1 mL/m2 increase in LAVI corresponded to a 1.03 OR risk for syncope. ROC analysis showed a LAVI threshold of 31.8mL/m2 for predicting syncope in all HCM (sensitivity 89.7%, specificity 40.4%) (Figure 1). Syncope showed a strong correlation in those with larger LAVI with incremental risk of syncope for each 1 mL/m2 added to LAVI size. Our findings suggest LAVI may have utility as a marker to stratify HCM patients at risk for syncope. Further studies in HCM patients are needed to assess the impact of changes in LAVI size over time on cardiovascular outcomes.

Description of teachers' knowledge on the occurrence of syncope in State Junior School 1 kabila bone

Syncope is an event of loss of consciousness and strength of a person's body that occurs from nowhere or without realizing it. The purpose of this study was to determine the description of the teacher's knowledge of the occurrence of syncope. This study uses a qualitative research design with analytical descriptive method. With as many as 5 informants’ teachers. This study uses data collection procedures by conducting observations, interviews and documentation. The procedure for checking the validity of the data uses peer discussion. Based on the results of research and interviews, it was found that, according to the informants, the description of the teacher's knowledge of syncope events is being able to know, understand, apply, analyze and evaluate syncope events that occur among students at school.

Antihypertensive treatment and risk factors for syncope in asymptomatic aortic stenosis patients with hypertension

ABSTRACT Background Evidence for treating hypertension in patients with asymptomatic aortic valve stenosis(AS) is scarce. Objectives Given the paucity of data on the relationship between syncope and antihypertensive treatment in aortic stenosis. This study sought to investigate this association in patients admitted to our hospital. Methods A total of 158 patients with asymptomatic moderate or severe aortic stenosis were analyzed. Follow-up was conducted by clinic visit, telephone contact, or review of electronic medical records. Outcomes were syncope. Results Hypertension were documented in 90 of the 158 patients with moderate or severe AS, and 77 of them received antihypertensive medications. During an average 28 months follow-up period, the occurrence of syncope was observed in 13 patients. Among them, 8 were in antihypertensive group (n = 77) and 5 in normotensive group (n = 68). There was no significant difference in incidence of syncope between the two groups. Patients with treated hypertension and syncope had a lower stroke volume index (SVi), a higher valve arterial impedance (ZVA), a smaller SAC than those without. Kaplan-Meier analysis showed that there was no significant difference in syncope cumulative incidence between antihypertensive group and normotensive group (log rank P = .478). Multivariate cox regression analysis showed that both ZVA (hazard ratio:19.006, 95% confidence interval: 4.664 to77.448;P = .002) and LVMI (hazard ratio:1.484, 95% confidence interval: 1.427 to 5.157;P = .016) were associated with development of syncope, whereas hypertension were not related independently to syncope (hazard ratio:0.935, 95% confidence interval: 0.786 to3.173; P = .869). Conclusions In patients with moderate or severe AS, concomitant hypertension, and antihypertensive treatment didn’t increase the occurrence of syncope, whereas higher ZVA was independently associated with greater risk of syncope.

Association of Occupational Distress and Low Sleep Quality with Syncope, Presyncope, and Falls in Workers

Syncope and presyncope episodes that occur during work could affect one’s safety and impair occupational performance. Few data are available regarding the prevalence of these events among workers. The possible role of sleep quality, mental stress, and metabolic disorders in promoting syncope, presyncope, and falls in workers is unknown. In the present study, 741 workers (male 35.4%; mean age 47 ± 11 years), employed at different companies, underwent clinical evaluation and blood tests, and completed questionnaires to assess sleep quality, occupational distress, and mental disorders. The occurrence of syncope, presyncope, and unexplained falls during working life was assessed via an ad hoc interview. The prevalence of syncope, presyncope, and falls of unknown origin was 13.9%, 27.0%, and 10.3%, respectively. The occurrence of syncope was associated with an increased risk of occupational distress (adjusted odds ratio aOR: 1.62, confidence intervals at 95%: 1.05–2.52), low sleep quality (aOR: 1.79 CI 95%: 1.16–2.77), and poor mental health (aOR: 2.43 CI 95%: 1.52–3.87). Presyncope was strongly associated with occupational distress (aOR: 1.77 CI 95%: 1.25–2.49), low sleep quality (aOR: 2.95 CI 95%: 2.08–4.18), and poor mental health (aOR: 2.61 CI 95%: 1.78–3.84), while no significant relationship was found between syncope or presyncope and metabolic syndrome. These results suggest that occupational health promotion interventions aimed at improving sleep quality, reducing stressors, and increasing worker resilience might reduce syncope and presyncope events in the working population.

Abstract 14357: Increased Left Atrial Volume Index is Associated With Syncope in Hypertrophic Cardiomyopathy Patients

Introduction: Syncope in hypertrophic cardiomyopathy patients (HCM) is associated with high risk for sudden death, presence of fibrosis and LV structural changes. However, it is unclear if left atrial structural changes associate with syncope. Our aim is to evaluate changes in left atrial volume index (LAVI) and occurrence of syncope in HCM patients. Methods: Retrospective study of 123 HCM patients identified at our institution from 2016-2019. Syncope was identified by chart review of ICD codes, past medical history, and keyword search. Left atrial volume index was determined by tracing the LA endocardial border from standard views in two-dimensional echocardiography. HCM subtypes were classified as obstructive (oHCM) and non-obstructive (noHCM). Results: A total of 123 patients, 29 (23.6%) had syncope. No difference in age, gender, or BMI was found between those with syncope and without syncope. More ventricular arrhythmic events and stroke events occurred in those with syncope vs. without syncope. LAVI showed a correlation with syncope in HCM patients (p&lt;0.05). Mean LAVI was larger in those with syncope compared to those without syncope (43.8±12.6 mL/m2 vs. 37.7±14.3 mL/m2). Each 1 mL/m2 increase in LAVI corresponded to a 1.03 OR risk for syncope. ROC analysis showed a LAVI threshold of 31.8mL/m2 for predicting syncope in all HCM (sensitivity 89.7%, specificity 40.4%) Conclusions: Syncope showed a strong correlation in those with larger LAVI with incremental risk of syncope for each 1 mL/m2 added to LAVI size. Additionally HCM patients with syncope had worse outcomes. Our findings suggest LAVI may have utility as a marker to stratify HCM patients at risk for syncope. Further studies in HCM patients are needed to assess the impact of changes in LAVI size over time on cardiovascular outcomes.

Frequency and predictors of physical trauma during reflex syncope

Abstract Background Reflex syncope is a common and generally benign condition; however, the occurrence of secondary trauma can be a potentially harmful complication. Identification of characteristics and conditions associated with trauma after syncope are important for clinicians. Purpose We aimed to investigate the frequency and predictors of secondary injury during reflex syncope in a large dataset from a tertiary syncope unit. Methods All patients referred with an episode of transient loss of consciousness between December 2017 and November 2020 were evaluated. Patients who received a diagnosis of reflex syncope based on 2018 European Society of Cardiology guidelines entered the study. Clinical characteristics, conditions surrounding syncope, and – in patients with a history of previous episodes – a detailed history of up to three prior syncopal attacks were documented. The primary outcome was the presence of any clinically relevant injury that was related to syncope. In a secondary per-episode analysis, the outcome was a combination of traumatic injuries related to the current and past syncopal episodes. Results Among 1258 consecutive patients with reflex syncope (Mean age: 42.3 years; 49.6% female), 239 (23.3%) had evidence of trauma in their initial visit. Female sex (prevalence ratio [PR]: 1.24; P=0.037), body mass index ≥25 kg/m2 (PR: 1.28; P=0.016), previous injury caused by syncope (PR: 1.63; P&amp;lt;0.001), occurrence of syncope in morning hours (PR: 1.90; P&amp;lt;0.001), occurrence of syncope at home (PR: 1.61; P&amp;lt;0.001), absence of prodromes (PR: 1.32; P=0.024), and standing position at the time of syncope (PR: 1.61; P&amp;lt;0.001) were associated with injury. Although family history of syncope was not related to injury, history of syncope in brother showed a significant association with secondary trauma (PR: 2.19; P=0.003). In multivariable logistic regression, five characteristics (previous injury after syncope, occurrence of syncope in the morning, occurrence of syncope at home, absence of prodromes, and standing position at the time of syncope) were independent predictors of injury. In the absence of all five conditions, the risk of injury was &amp;lt;3%. In the secondary per-syncope analysis, of 2849 syncopal episodes, 1028 (36.1%) were associated with trauma. Having syncope in the morning (PR: 1.34; P&amp;lt;0.001), occurrence of syncope at home (PR: 1.51; P&amp;lt;0.001), absence of prodromes (PR: 1.34; P&amp;lt;0.001), and standing position at the time of syncope (PR: 1.55; P&amp;lt;0.001) were again associated with injury. Conclusions Secondary trauma after reflex syncope is a common complication. Specific conditions at the time of syncope are associated with traumatic injuries, suggesting that interventions to avoid syncopal attacks in those conditions might reduce secondary trauma. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Tehran University of Medical Sciences

Syncope associated with supraventricular tachycardia: Diagnostic role of implantable loop recorders.

Syncope represents a relatively uncommon symptom of supraventricular tachycardia (SVT). It is likely that an impaired autonomic vasomotor response to the hemodynamic stress of tachycardia is the determinant of hemodynamic changes leading to cerebral hypoperfusion and syncope. In this regard, tilt‐table test may detect abnormalities in the autonomic nervous function and predict the occurrence of syncope during SVT. Electrophysiology studies may reproduce the SVT, distinguish it from other life‐threatening ventricular tachyarrhythmias, and exclude other causes of syncope. Not infrequently mixed syncope mechanisms are revealed during the above diagnostic workup raising doubts about the operating mechanism in the clinical setting. In such cases of uncertainty, an implantable loop recorder, providing long‐term cardiac monitoring, may play a pivotal role in the establishment of the diagnosis, confirming the association of an arrhythmic event with the symptom. Herein, we present four such cases with recurrent unexplained syncope finally attributed to paroxysmal SVT guiding them to a potentially radical treatment through radiofrequency catheter ablation.

A Reading of Fragments 926(a) and 926(g) PMG within the Context of the New Music

There has been much controversy regarding the date, the performative context, and the generic quality of fragment 926 PMG, which has been preserved on papyrus (P. Oxy. 9 + P. Oxy 2687) in a rhythmical treatise by an unknown author. The verse fragments on this papyrus were composed in iambic dactyls (∪ — ∪ –) and used as examples of the occurrence of syncope in various lyric meters. Fragments 926(a) and (g) PMG are from a composition performed by a maiden chorus which bear similarities to Alcman’s partheneia and have affinities with archaic epic and lyric poetry. Supposedly, these fragments might have been fragments of partheneia composed in the time of the New Music. Nonetheless, they are not shaped according to the bulk of the aesthetic values and the compositional rules of the New Music. These fragments seem to belong to cultic songs created for maiden choruses, possibly, to honor Dionysus. The alternative is that they imitate such songs within a dramatic context. We may assume that these quasi-dithyrambic partheneia were composed to serve religious needs or at least imitated cultic songs. They looked backward to the archaic and early classical tradition of partheneia, and their existence is an indication that, in the days of the New Music, there was a poetic tradition upheld by “reactionary” poets.

Prospective Study of Pulmonary Embolism Presenting as Syncope.

Syncope represents a common condition among the general population. It is also a frequent complaint of patients in the emergency department (ED). Pulmonary embolism (PE) considers a differential diagnosis, particularly in a case of syncope without chest pain. What is the prevalence of PE among patients who presented an episode of syncope to the ED and among those hospitalized for syncope in a tertiary care hospital? From January 2012 to December 2017, we conducted a prospective observational study among adult patients presenting themselves to the ED consecutively or admitted for syncope. Syncope and PE were defined by professional guidelines. PE was ruled out in patients who had a low pretest clinical probability, as per Wells score and a negative D-dimer assay. In other patients, computed tomography pulmonary angiography was performed. Seventeen thousand eight-two patients (mean age 71.3 ± 13.24 years) visited the ED for syncope. PE was detected in 45 patients (mean age 65.75 ± 9.45 years): 4 with low risk, 26 with intermediate risk, and 15 with high risk. The prevalence of PE in those hospitalized with syncope was 11.47%, which is 45 of 392 (confidence interval 95% 8.48-15.04), and was 2.52%, 45 of 1782 (confidence interval 95% 1.8-3.3), in patients presenting with syncope to the ED. The location of the embolus was bilateral in 24 patients (53.33%), in a main pulmonary artery in 10 (22.22%), in a lobar artery in 10 (22.22%), and in a segmental artery in 1 (2.22%). The occurrence of syncope, if not explained otherwise, should alert one to consider PE as a differential diagnosis. PE rate, presenting as syncope, is the highest in patients with large thrombi, which is responsible for bilateral or proximal obstruction in a main or lobar pulmonary artery.

Acute reduction in posterior cerebral blood flow following isometric handgrip exercise is augmented by lower body negative pressure.

The mechanism(s) for the increased occurrence of a grayout or blackout, syncope, immediately after heavy resistance exercise are unclear. It is well‐known that orthostatic stress increases the occurrence of postexercise syncope. In addition, previous findings have suggested that hypo‐perfusion, especially in the posterior cerebral circulation rather than anterior cerebral circulation, may be associated with the occurrence of syncope. Herein, we hypothesized that the postexercise decrease in posterior, but not anterior, cerebral blood flow (CBF) would be greater during orthostatic stress. Nine healthy subjects performed 3‐min isometric handgrip (HG) at 30% maximum voluntary contraction without (CONTROL) and during lower body negative pressure (LBNP; −40 Torr) while vertebral artery (VA) blood flow, as an index of posterior CBF, and middle cerebral artery blood velocity (MCAv), as an index of anterior CBF, were measured. Immediately after HG (0 to 15 sec of recovery phase), mean arterial pressure decreased but there was no difference in this reduction between CONTROL and LBNP conditions (−15.4 ± 4.0% and −17.0 ± 6.2%, P = 0.42). Similarly, MCAv decreased following exercise and was unaffected by the application of LBNP (P = 0.22). In contrast, decreases in VA blood flow immediately following HG during LBNP were significantly greater compared to CONTROL condition (−24.2 ± 9.5% and ‐13.4 ± 6.6%, P = 0.005). These findings suggest that the decrease in posterior CBF immediately following exercise was augmented by LBNP, whereas anterior CBF appeared unaffected. Thus, the posterior cerebral circulation may be more sensitive to orthostatic stress during the postexercise period.

SCN5A gene mutations and the risk of ventricular fibrillation and syncope in Brugada syndrome patients: A meta-analysis.

Mutations in the gene encoding the main cardiac sodium channel (SCN5A) are the commonest genetic cause of Brugada syndrome (BrS). However, the effect of SCN5A mutations on the outcomes of ventricular fibrillation (VF) and syncope remains uncertain. To clarify this relationship, a meta‐analysis was performed. A comprehensive search was conducted to identify all eligible studies from PubMed, MEDLINE, EBSCO, ProQuest, Science Direct, Clinical Key, and Cochrane database for cohort studies of BrS populations that had been systematically tested for SCN5A mutations. We did meta‐analysis to see the relationship between SCN5A mutations and the occurrence of VF and/or syncope using RevMan 5.3. Five clinical studies met our criteria and included a total of 665 BrS patients. These studies included 45 patients with VF and 178 patients with syncope. We found that in BrS patients with SCN5A mutations the rate of VF event was 30.7% while in patients without mutations was 28.5% (Risk Ratio [RR] = 1.11, [95% CI: 0.61, 2.00], P = 0.73, I 2 = 0%). The occurrence of syncope events was 35.9% in patients with SCN5A mutations and 34.5% in patients without mutations (RR = 1.12, [95% CI: 0.87, 1.45], P = 0.37, I 2 = 39%). Furthermore, the occurrence of combined VF and syncope events were similar between the 2 groups (RR = 1.12, [95% CI: 0.89, 1.42], P = 0.34, I 2 = 11%). BrS patients with SCN5A mutations exhibit a similar risk of future occurence of VF and/or syncope as compared to those without SCN5A mutations.