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Variability of cardioinhibition in vasovagal syncope: differences between subgroups during cardioinhibition and

Ineke A van Rossum1, Frederik J de Lange2, David G Benditt3

  • 1Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300, Leiden, The Netherlands. i.a.van_rossum@lumc.nl.

Clinical Autonomic Research : Official Journal of the Clinical Autonomic Research Society
|October 24, 2023
PubMed

Insights

Individuals with marked cardioinhibition experience a faster and larger heart rate drop during vasovagal syncope. These hemodynamic differences are evident before the syncope event begins.

Area of Science:

  • Cardiology
  • Autonomic Nervous System Function

Background:

  • Vasovagal syncope involves a complex interplay of neural and cardiovascular factors.
  • Cardioinhibition, a key component, manifests as a significant heart rate decrease during syncope.
  • Understanding variations in cardioinhibition severity is crucial for patient management.

Purpose of the Study:

  • To compare hemodynamic parameters in individuals with varying degrees of cardioinhibition during vasovagal syncope.
  • To investigate whether hemodynamic differences precede the onset of cardioinhibition.

Main Methods:

  • 149 subjects experiencing vasovagal syncope during tilt-table testing were included.
  • Subjects were categorized into marked, intermediate, and minimal cardioinhibition groups based on heart rate decrease.
  • Hemodynamic parameters were assessed in supine, post-tilt, and cardioinhibitory phases.

Main Results:

  • Subjects with marked cardioinhibition exhibited higher heart rates before and during syncope compared to other groups.
  • The heart rate decrease was significantly larger and more rapid in the marked cardioinhibition group.
  • Hemodynamic profiles differed among groups even before the tilt maneuver.

Conclusions:

  • Marked cardioinhibition is characterized by a more pronounced and accelerated heart rate reduction.
  • Pre-existing hemodynamic variations contribute to the development of marked cardioinhibition.
  • These findings highlight distinct physiological profiles associated with different severities of cardioinhibition.
Abstract

Keywords:
CardioinhibitionReflex syncopeTilt-table testingVasovagal syncope

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