Recurrent Syncope Research Articles

Isolated heart block in snake bite: Recurrent syncope as presenting symptom

Isolated heart block in snake bite: Recurrent syncope as presenting symptom

Cardioneuroablation as a Therapeutic Approach for Functional AV Block Presenting Late After AVNRT Ablation.

Atrioventricular block (AVB) is a rare but serious acute complication of atrioventricular nodal reentrant tachycardia (AVNRT) ablation. Additionally, compared to the general population, patients who undergo AVNRT ablation have an increased risk of requiring pacemaker implantation due to late-onset AVB. Cardioneuroablation (CNA) has emerged as a promising alternative to pacemaker implant in patients with recurrent cardioinhibitory reflex syncope and functional cardiac conduction disorders. However, its role in managing late AVB post-AVNRT ablation has not been established. This prospective study included three patients who experienced syncope due to paroxysmal AVB 97-127 months after successful AVNRT ablation. All patients exhibited normal infrahisian conduction and preserved functional reserve of suprahisian conduction, as assessed by an atropine test. CNA was performed using a biatrial approach with the Ensite X EP System, guided by both anatomical mapping and local fragmented atrial electrograms. Radiofrequency (RF) energy was delivered to the inferior paraseptal ganglionated plexus (IPSGP) and the left superior ganglionated plexus (LSGP). Acute procedural success was defined as complete abolition of atropine response at the atrioventricular node. Clinical success was defined as no recurrence of syncope, no cardioinhibitory response during tilt testing, and normal conduction on Holter monitoring. Acute procedural success was achieved in all cases, with significant reductions in the antegrade Wenckebach point (AWP) following RF ablation at the IPSGP and LSGP. Post-CNA atropine tests showed no changes in AH interval or AWP response in any patient. Post-CNA tilt testing revealed vasodepressor responses in all patients, and Holter monitoring showed no conduction abnormalities. During follow-up (6-13 months), all patients remained free of syncope. CNA appears to be a promising alternative to pacemaker implantation for patients with late-onset paroxysmal AVB following AVNRT ablation. Targeting the IPSGP, in particular, may be crucial for optimizing outcomes. Larger studies are needed to confirm these findings and evaluate the long-term efficacy of CNA in this patient population.

Catecholaminergic Polymorphic Ventricular Tachycardia Caused by a Homozygous Pathogenic Variant in Calsequestrin 2 Gene

The article presents a clinical case of a 19-year-old patient with catecholaminergic polymorphic ventricular tachycardia caused by the pathogenic homozygous variant p.Ile193Asnfs*17 (rs397516643) in the CASQ2 gene, the early manifestations of which were recurrent syncope during emotional stress, supraventricular and polymorphic ventricular arrhythmias in the absence of structural changes in the heart. The article showed the evolution of heart rhythm disorders during the observation period. The authors discussed the issues of risk stratification for sudden cardiac death and the strategy for its prevention in this pathology.

Left ventricular thrombus as a rare complication of pulmonary tuberculosis

Tuberculosis (TB) continues to pose a significant public health burden in endemic regions, remaining a leading cause of morbidity and mortality. Although TB is associated with a range of complications, the occurrence of intracardiac thrombus is an exceptionally rare manifestation. We report the case of a 62-year-old male with active pulmonary TB, who had been on anti-tubercular therapy for one month and presented with recurrent syncope and exertional dyspnea. Transthoracic 2D echocardiography revealed a large, mobile thrombus in the left ventricular apex. Evaluation for underlying hypercoagulable states was unremarkable. The patient was managed with anticoagulation therapy in conjunction with ongoing anti-tubercular treatment. This case underscores the importance of clinical vigilance for rare thrombotic complications in TB to facilitate timely diagnosis and appropriate management.

Кардіонейроабляція в лікуванні вазовагального синкопе. Сьогодення та перспективи

The aim – considering worldwide experience, it is necessary to analyze scientific articles about ablation of ganglion plexi (GP) (cardioneuroabaltion) for patients with vasovagal syncope (VVS).Searching scientific articles was performed with well-known online-library PubMed. 203 articles were found in different scientific journals. The selection of patients is an essential factor during preprocedural period in order to predict results of cardioneuroablation. Ablation of ganglion plexi in both right and left atrium has showed the best effectiveness. Moreover, extracardiac vagal stimulation may be an advanced method to check acute results after parasympathetic denervation.The first article about treatment of VVS has been published by Pachon et al. in 2005, that presented the reduced rate of recurrent syncope after cardioneuroabaltion. Results of the first randomized clinical trial have been published by R. Piotrowski et al., in which 48 patients were enrolled and were divided into two groups of 24 patients respectively. Group, where cardioneuroablation was performed, has the decreased level of the recurrence syncope in contrast with group, where conservative therapy was introduced (8 % and 54 % respectively). The first randomized clinical trial comparing clinical impact between pacemaker implantation and cardioneuroablation have being started in 2024 (TELE-SPACER).Conclusions. The choosing of the appropriate method of treatment in patients with VVS is still discussed. Cardineuroablation may be become an effective and safe option especially in young people.

Insomnia due to a dislocation storm in hypermobile Ehlers-Danlos syndrome with small fibre neuropathy and recurrent syncope.

To report on a patient with hypermobile Ehlers-Danlos syndrome (EDS) with SFN in whom frequent dislocations during sleep led to sleep deprivation. The patient is a 19-year-old female with hypermobile EDS manifested by frequent dislocations of large joints and small fiber neuropathy (SFN) presenting as recurrent syncope. The dislocations occurred spontaneously or triggered by voluntary or involuntary movements with such frequency, even during the night, that sleep was disturbed. The maximum sleep duration was between 4 and 5 hours. Bedding, analgesics, muscle relaxants and physiotherapy only marginally improved the pain and discomfort caused by the dislocations. This case demonstrates that hypermobile EDS can manifest phenotypically with insomnia due to pain and discomfort from frequent dislocations during the night. Patients with hypermobile EDS should undergo polysomnography to determine the cause of the sleep disturbance and initiate the most appropriate treatment for insomnia in a timely manner.

Recurrent Syncope Secondary to High-dose Loperamide Dependence in a Patient with Bipolar Disorder: A Case Report.

Recurrent Syncope Secondary to High-dose Loperamide Dependence in a Patient with Bipolar Disorder: A Case Report.

A Complex Phenotype in an Adult with Recurrent Syncope (P8-5.020)

A Complex Phenotype in an Adult with Recurrent Syncope (P8-5.020)

Recurrent Syncope Secondary to Carotid Sinus Syndrome in a Patient with Laryngeal Cancer: A Case Report (P11-2.003)

Recurrent Syncope Secondary to Carotid Sinus Syndrome in a Patient with Laryngeal Cancer: A Case Report (P11-2.003)

Efficacy of cardioneuroablation for vasodepressor vasovagal syncope.

Cardioneuroablation (CNA) is effective for cardiac inhibitory and mixed vasovagal syncope (VVS) but not for vasodepressor VVS. This study aimed to assess the therapeutic benefits of CNA in vasodepressor VVS. VVS patients hospitalized in the Department of Cardiology of Jiangxi Provincial People's Hospital were retrospectively reviewed. Holter monitoring was performed before, during, and 3 months after CNA. Changes in heart rate and atrioventricular conduction before and after ablation were compared. Thirty-five patients (18 M/17F, 47.48 ± 16.49 years) were included. Median duration of syncope was 24.0 months (range, 2.5-66.0). Median number of syncope episodes before treatment was two (range, 2-4). The time domain indexes of heart rate variability, mean heart rate, maximum heart rate, and minimum heart rate were significantly higher 3 months after CNA. Mean follow-up was 11 ± 4.67 months. Recurrent syncope occurred in two patients with vasodepressor VVS, one of them with presyncope symptoms in vasodepressor type; and one patient occurred with mixed VVS, without presyncope symptoms. The syncope free survival is 76.92%. No serious complications occurred. CNA is safe and effective in the treatment of vasodepressor VVS. CNA is effective for treating vasodepressor VVS. Our study provides a theoretical basis for individualization of treatment in patients with vasodepressor VVS.

A study on the therapeutic effect of zero-ray cardiac autonomic ganglion ablation on vasovagal syncope in a special occupational young population.

This study aims to evaluate the safety and efficacy of zero-ray radiofrequency ablation of the cardiac autonomic ganglionic plexus (GP) for treating vasovagal syncope (VVS) in young individuals undergoing high-intensity physical training. We retrospectively analyzed data from 35 young individuals with recurrent syncope (≥3 syncopal episodes within the year prior to the procedure) who underwent GP ablation at our hospital between May 2021 and January 2023. Among them, 33 (94.3%) were male, with a mean age of 22.7 ± 4.6 years. Systemic diseases and/or organic heart conditions that could cause syncope were excluded through comprehensive examinations upon admission. GP ablation was performed in patients with a positive upright tilt test. During the procedure, zero-ray septal puncture was guided by intracardiac ultrasound, and the GP was localized using the anatomical approach (AA) as the ablation target. The ablation endpoint was defined as an increase in heart rate to approximately 90 beats per minute. The safety and efficacy of the procedure were assessed by comparing preoperative and postoperative data, including heart rate, sinus node recovery time, atrioventricular (AV) Wenckebach point, heart rate variability (HRV), deceleration capacity of the heart (DC), and the occurrence of arrhythmias. No intraoperative or postoperative complications were observed with zero-ray intracavitary ultrasound-guided GP ablation. Postoperatively, the sinus node recovery time and AV Wenckebach point were significantly shorter compared to preoperative values (P < 0.001). Both the postoperative mean ECG heart rate and the 12-month postoperative Holter mean heart rate were significantly higher than preoperative levels (P < 0.001). Additionally, sDANN-24, rMSSD, and deceleration capacity (DC) were significantly reduced postoperatively (P < 0.001). The follow-up period ranged from a minimum of 15 months to a maximum of 35 months. Within one year after surgery, two cases experienced a single episode of syncope, and one case reported a single episode of a syncopal premonitory aura. In the patient with a syncopal premonitory aura, outpatient ECG and Holter monitoring showed no abnormalities. The patient who experienced syncope was readmitted for further evaluation, including ECG, Holter monitoring, and an upright tilt test, which was negative. Two postoperative cases (one with a syncopal premonitory aura and one without syncope) exhibited second-degree type II AV block on Holter monitoring, which occurred during nocturnal sleep. Despite this, both groups were able to continue high-intensity physical training with significant symptomatic improvement. Zero-ray cardiac GP ablation is a radiation-free, minimally invasive, safe, and effective treatment for young VVS patients undergoing high-intensity physical training.

Simplified three ganglionated plexus ablation for the treatment of recurrent vasovagal syncope and functional bradyarrhythmias.

Simplified three ganglionated plexus ablation for the treatment of recurrent vasovagal syncope and functional bradyarrhythmias.

Recurrent Syncope in a 27-Year-Old Primigravida

Recurrent Syncope in a 27-Year-Old Primigravida

A New Approach to the Etiology of Syncope: Infection as a Cause.

Syncope is a common clinical occurrence, with neurally mediated and orthostatic types accounting for about 75% of cases. The exact pathophysiological mechanisms remain unclear, with recent evidence suggesting autonomic nervous system damage and a potential infectious etiology. This study aimed to examine the role of infection in the development of syncope and orthostatic hypotension (OH). The cross-sectional study included 806 patients from the Neurocardiological Laboratory of the Institute for Cardiovascular Diseases "Dedinje". Patients were divided into three groups: unexplained recurrent syncope (n = 506), syncope with OH during the head-up tilt test (HUTT) (n = 235), and OH without a history of syncope (n = 62). All participants underwent the HUTT, and 495 underwent serological testing for various microorganisms. Data were analyzed using chi-squared tests and binary and multinomial logistic regression. The HUTT was positive in 90.6% of patients with syncope and OH, compared with 61.6% with syncope alone (p < 0.001). Serological testing revealed that 57.85% of syncope patients, 62.9% of syncope with OH patients, and 78% of OH patients had positive IgM antibodies to at least one microorganism. Multivariate analysis indicated that IgM antibodies to Coxsackievirus and Epstein-Barr virus were significant predictors of OH. This study demonstrated a potential association between infections and syncope/OH. Further investigation into the role of infectious agents in autonomic dysfunction is warranted to clarify the underlying mechanisms of syncope and OH.

Haemodynamic Patterns in Reflex Syncope: Insights from Head-Up Tilt Tests in Adults and Children.

Introduction: Vasovagal syncope is a prevalent condition marked by transient loss of consciousness due to abrupt decreases in systemic blood pressure and/or heart rate. Despite its clinical impact, the underlying haemodynamic mechanisms remain poorly defined, and data on age-related differences are limited and sometimes contradictory. Objectives: This study aimed to characterise haemodynamic adaptation patterns during a head-up tilt (HUT) test in adult (≥18 years) and paediatric (<18 years) patients with recurrent reflex syncope, compared with healthy adult controls. We sought to identify distinct temporal haemodynamic signatures and clarify potential age-related differences in syncope mechanisms. Methods: In this prospective observational study, participants underwent continuous beat-to-beat monitoring of cardiac output (CO), stroke volume (SV), heart rate (HR), and total peripheral resistance (TPR) during HUT. Linear mixed-effects models were used to examine time-by-group interactions, and post-hoc analyses were adjusted for multiple comparisons. Effect sizes and confidence intervals (CIs) were reported to quantify the magnitude of differences. Results: A total of 187 fainters (paediatric n = 81, adult n = 106) and 108 non-fainters (including 30 healthy controls) were studied. Compared to adult fainters, paediatric fainters showed a 24% larger decline in CO from baseline (mean difference of 1.1 L/min [95% CI: 0.5-1.7], p = 0.003) and a 15-20 bpm higher peak HR (p = 0.001) during presyncope. Both subgroups experienced significant drops in TPR, which were more pronounced in paediatric fainters (effect size = 0.27, 95% CI: 0.12-0.42). Non-fainters (including controls) maintained relatively stable haemodynamics, with no significant decrease in CO or TPR (p > 0.05). Age-related comparisons indicated a heavier reliance on HR modulation in paediatric fainters, leading to an earlier transition from compensated to pre-syncopal states. Conclusions: These findings demonstrate that paediatric fainters exhibit more abrupt decreases in CO and TPR than adults, alongside higher HR responses during orthostatic stress. Targeted interventions that address this heightened chronotropic dependency-such as tilt-training protocols or strategies to improve venous return-may be particularly beneficial in younger patients. An age-specific approach to diagnosis and management could improve risk stratification, minimise recurrent episodes, and enhance patient outcomes.

A practice teaching from GIMSI (Italian Multidisciplinary Syncope Group) 2025: yoga as a treatment for recurrent vasovagal syncope

The XII Italian National Congress of GIMSI (Italian Multidisciplinary Syncope Group) has taken place in Milan on February 6-7, 2025. This report summarizes a practice teaching from the congress regarding the role of yoga and physical exercise in managing Vasovagal Syncope (VVS). VVS is a very common clinical condition with an estimated lifetime prevalence of 35%1 and a frequent reason for emergency department visits.2 Although VVS is not associated with an increased rate of mortality, there is a significant deterioration in the Quality Of Life (QoL) in conjunction with the severity and frequency of recurrences.3 Pharmacological and non-pharmacological therapies, such as elastic compression stocking, dietary modification with oral rehydration salts and increased salt intake, tilt training (also known as standing training), and physical counter-pressure manoeuvres, have demonstrated only limited and modest efficacy, which can be frustrating for both patients and clinicians.4,5 There is no single uniformly accepted protocol to prevent VVS recurrences and some patients with recurrent syncope end up being submitted to procedures, such as pacemaker implantation or cardioneuroablation. The latter is showing promising results, but it is an invasive manoeuvre, and its long-term effects are unknown.6 [...]

First experience with a new tool for automatic mapping of fragmented signals in a case report of cardioneuroablation.

Cardioneuroablation is a treatment option for patients with recurrent vasovagal syncope (VVS). Ablation targets of parasympathetic ganglionated plexi (GP) adjacent to the right and left atrial walls and distal endocardial inputs of these GP can be identified both by their anatomical localization and by intracardiac mapping of fragmented electrogram signals. In this case of a successful cardioneuroablation of a 22-year-old patient suffering from recurrent VVS, a new algorithm for automatic mapping of fragmented signals (CARTO Elevate Module, Biosense Webster) was used to identify areas of GP. In this first experience, automatic tags of fragmented signals were matching well with anatomically guided ablation points. This new tool for automatic identification of fragmented signals may facilitate and improve cardioneuroablation procedures.

Direct Visualization of External Outflow Graft Obstruction in Durable Left Ventricular Assist Device Using Transthoracic Echocardiography

External outflow graft obstruction (OGO) in durable left ventricular assist devices (LVADs) is a rare but critical complication. Detecting external OGO can be challenging because of its nonspecific symptoms and a wide variety of differential diagnoses. We report the case of a 45 year old man with LVAD admitted with complaints of recurrent syncope and frequent low-flow alarms. Laboratory tests and chest radiography revealed no specific findings. Transthoracic echocardiography via the left subcostal approach revealed an outflow graft compressed by a low-echo area within a bend relief. This finding led to a diagnosis of external OGO, which was consistent with what was observed on contrast-enhanced computed tomography. The patient underwent surgery and the gelatinous substance compressing the outflow graft was successfully removed. This case highlights the utility of transthoracic echocardiography as a noninvasive and effective method for detecting external OGOs, emphasizing its role as a valuable tool for the initial screening of patients with suspected OGO.

Recurrent syncope attributed to torsade de pointes induced by worsened long QT interval after switching from peritoneal dialysis to hemodialysis: A case report

Recurrent syncope attributed to torsade de pointes induced by worsened long QT interval after switching from peritoneal dialysis to hemodialysis: A case report

Heart Transplantation Outcomes in Pediatric Patients with Noonan Syndrome: An Institutional Case Series.

Noonan syndrome is an autosomal dominant genetic condition associated with cardiac manifestations that may necessitate heart transplantation. This case series describes the short- and medium-term outcomes in five patients with Noonan syndrome status-post heart transplant followed at our institution. Retrospective, single center chart review of the electronic medical record in post-heart transplant patients with a diagnosis of Noonan syndrome. Five out of 88 heart transplant patients at our institution had genetically confirmed Noonan syndrome with either RAF1 or PTPN11 mutations. All patients were noted to have hypertrophic cardiomyopathy. Severe outflow tract obstruction, in conjunction with comorbidities such as intractable arrhythmias, recurrent syncope, and failure to thrive were leading indications for heart transplant. The most common complications post-heart transplant included recurrent viral infections and pleural and pericardial effusions. Isolated complications included lymphangiectasias, posterior reversible encephalopathy syndrome, and aspergillus pneumonia. Feeding difficulties were common. All patients are alive at the time of this publication. Noonan syndrome is highly associated with hypertrophic cardiomyopathy, and severe cases may necessitate heart transplantation. The post-heart transplant complications seen in our cohort are not unique to the Noonan syndrome population. Survival post-heart transplant is high.