The Rate of Asystolic Reflex Syncope Is Not Influenced by Age
Brignole, Michele ; Groppelli, Antonella ; Russo, Vincenzo ; Fedorowski, Artur LU
; van Dijk, Gert
and Alboni, Paolo
(2024)
In JACC: Clinical Electrophysiology
10(3).
p.566-574
- Abstract
BACKGROUND: The head-up tilt test (HUT) and other evidence suggest that the vagal effect on the heart decreases with age.
OBJECTIVES: The main aim of the study was to assess whether this age effect also affects the rate of asystole in spontaneous reflex syncope (RS).
METHOD: We performed an analysis of pooled individual data from 4 studies that recruited patients ≥40 years of age affected by certain or suspected RS who received an implantable loop recorder (ILR) and reported follow-up data on syncope recurrence. We assessed the presence of asystolic syncope of >3 seconds or nonsyncopal asystole of >6 seconds recorded by ILR and compared the findings to tilt test results on the same patients.
RESULTS: A total of... (More)
BACKGROUND: The head-up tilt test (HUT) and other evidence suggest that the vagal effect on the heart decreases with age.
OBJECTIVES: The main aim of the study was to assess whether this age effect also affects the rate of asystole in spontaneous reflex syncope (RS).
METHOD: We performed an analysis of pooled individual data from 4 studies that recruited patients ≥40 years of age affected by certain or suspected RS who received an implantable loop recorder (ILR) and reported follow-up data on syncope recurrence. We assessed the presence of asystolic syncope of >3 seconds or nonsyncopal asystole of >6 seconds recorded by ILR and compared the findings to tilt test results on the same patients.
RESULTS: A total of 1,046 patients received ILR because of unexplained syncope. Of these, 201 (19.2%) had a documentation of an asystolic event of 10-second (Q1-Q3: 6- to 15-second) duration. They were subdivided in 3 age tertiles: ≤60 years (n = 64), 61 to 72 years (n = 72), and ≥73 years (n = 65). The rate of asystolic events was similar in the 3 subgroups (50.1%, 50.1%, and 49.2%, respectively; P = 0.99). Conversely, the rate of asystolic syncope induced during HUT (performed in 169 of 201) was greatly age dependent (31.0%, 12.1%, and 11.1% in increasing age tertiles, respectively; P = 0.009).
CONCLUSIONS: The rate of the spontaneous asystolic form of RS documented by ILR is constant at any age >40 years. Conversely, the rate of asystolic syncope induced by HUT is higher in younger patients and decreases with age. The contrasting results between spontaneous and tilt-induced events cast doubt on the concept that asystole in RS is less common in older patients.
(Less)
- author
- Brignole, Michele
; Groppelli, Antonella
; Russo, Vincenzo
; Fedorowski, Artur
LU
; van Dijk, Gert
and Alboni, Paolo
- organization
- publishing date
- 2024-01-17
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- atrioventricular block, implantable loop recorder, neurally mediated, reflex, sinus arrest, syncope, tilt testing
- in
- JACC: Clinical Electrophysiology
- volume
- 10
- issue
- 3
- pages
- 9 pages
- publisher
- Elsevier
- external identifiers
-
- scopus:85187571555
- pmid:38243997
- ISSN
- 2405-5018
- DOI
- 10.1016/j.jacep.2023.11.021
- language
- English
- LU publication?
- yes
- id
- 36950c9b-5998-4eda-bfe5-09ddfa634402
- date added to LUP
- 2024-01-22 14:41:54
- date last changed
- 2024-04-18 04:03:32
@article{36950c9b-5998-4eda-bfe5-09ddfa634402,
abstract = {{<p>BACKGROUND: The head-up tilt test (HUT) and other evidence suggest that the vagal effect on the heart decreases with age.</p><p>OBJECTIVES: The main aim of the study was to assess whether this age effect also affects the rate of asystole in spontaneous reflex syncope (RS).</p><p>METHOD: We performed an analysis of pooled individual data from 4 studies that recruited patients ≥40 years of age affected by certain or suspected RS who received an implantable loop recorder (ILR) and reported follow-up data on syncope recurrence. We assessed the presence of asystolic syncope of >3 seconds or nonsyncopal asystole of >6 seconds recorded by ILR and compared the findings to tilt test results on the same patients.</p><p>RESULTS: A total of 1,046 patients received ILR because of unexplained syncope. Of these, 201 (19.2%) had a documentation of an asystolic event of 10-second (Q1-Q3: 6- to 15-second) duration. They were subdivided in 3 age tertiles: ≤60 years (n = 64), 61 to 72 years (n = 72), and ≥73 years (n = 65). The rate of asystolic events was similar in the 3 subgroups (50.1%, 50.1%, and 49.2%, respectively; P = 0.99). Conversely, the rate of asystolic syncope induced during HUT (performed in 169 of 201) was greatly age dependent (31.0%, 12.1%, and 11.1% in increasing age tertiles, respectively; P = 0.009).</p><p>CONCLUSIONS: The rate of the spontaneous asystolic form of RS documented by ILR is constant at any age >40 years. Conversely, the rate of asystolic syncope induced by HUT is higher in younger patients and decreases with age. The contrasting results between spontaneous and tilt-induced events cast doubt on the concept that asystole in RS is less common in older patients.</p>}},
author = {{Brignole, Michele and Groppelli, Antonella and Russo, Vincenzo and Fedorowski, Artur and van Dijk, Gert and Alboni, Paolo}},
issn = {{2405-5018}},
keywords = {{atrioventricular block; implantable loop recorder; neurally mediated; reflex; sinus arrest; syncope; tilt testing}},
language = {{eng}},
month = {{01}},
number = {{3}},
pages = {{566--574}},
publisher = {{Elsevier}},
series = {{JACC: Clinical Electrophysiology}},
title = {{The Rate of Asystolic Reflex Syncope Is Not Influenced by Age}},
url = {{http://dx.doi.org/10.1016/j.jacep.2023.11.021}},
doi = {{10.1016/j.jacep.2023.11.021}},
volume = {{10}},
year = {{2024}},
}