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[Is there a malignant neurocardiogenic syncope?].
1Servicio de Electrocardiografía y Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, INCICH, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, 14080 México, D. F.
Archivos De Cardiologia De Mexico
|May 11, 2002
Summary
Malignant neurocardiogenic syncope involves frequent, severe fainting spells without warning. This condition, characterized by prolonged asystole, requires careful evaluation and diverse therapeutic strategies.
Area of Science:
- Cardiology
- Neurology
Context:
- A subset of patients experience frequent, severe neurocardiogenic syncope (NCS) with traumatic outcomes.
- This severe form is termed 'malignant NCS', often associated with profound bradycardia and asystole exceeding 5 seconds.
Purpose:
- To define the clinical features of malignant NCS.
- To evaluate the utility of the head-up tilt test (HUTT) in assessing this subgroup.
- To review proposed therapeutic interventions for malignant NCS.
Summary:
- Malignant NCS is characterized by recurrent syncope, often without prodromal symptoms and potentially leading to traumatic events.
- Prolonged asystole (>5 seconds) is a frequent finding, but equating 'malignant' solely with asystole duration may cause prognostic and therapeutic errors.
- The article details clinical presentation, HUTT's role in therapeutic evaluation, and treatments like beta-blockers, DDD pacemakers, and tilt training.
Impact:
- Clarifies the definition and diagnostic approach for malignant NCS.
- Highlights the importance of HUTT in guiding treatment decisions for refractory syncope.
- Provides a comprehensive overview of therapeutic options for a challenging patient group, potentially improving patient outcomes.