Tests for the identification of reflex syncope mechanism
Brignole, Michele ; Rivasi, Giulia ; Fedorowski, Artur LU
; Ståhlberg, Marcus
; Groppelli, Antonella
and Ungar, Andrea
(2023)
In Expert Review of Medical Devices
20(2).
p.109-119
- Abstract
INTRODUCTION: Treatment efficacy of reflex syncope is mainly related to the mechanism underlying syncope rather than its etiology or clinical presentation. The predominant mechanism underlying reflex syncope can be assigned to hypotensive or to bradycardic phenotypes.
AREAS COVERED: Methodology and diagnostic criteria of the most useful tests for the identification of hypotensive and bradycardic phenotypes are discussed. Diagnostic tests for the hypotensive phenotype include office blood pressure measurement with active standing test, home, and wearable blood pressure monitoring, 24-h ambulatory blood pressure monitoring and tilt table test. Diagnostic tests for the bradycardic phenotype include carotid sinus massage, tilt table... (More)
INTRODUCTION: Treatment efficacy of reflex syncope is mainly related to the mechanism underlying syncope rather than its etiology or clinical presentation. The predominant mechanism underlying reflex syncope can be assigned to hypotensive or to bradycardic phenotypes.
AREAS COVERED: Methodology and diagnostic criteria of the most useful tests for the identification of hypotensive and bradycardic phenotypes are discussed. Diagnostic tests for the hypotensive phenotype include office blood pressure measurement with active standing test, home, and wearable blood pressure monitoring, 24-h ambulatory blood pressure monitoring and tilt table test. Diagnostic tests for the bradycardic phenotype include carotid sinus massage, tilt table test and prolonged ECG monitoring.
EXPERT OPINION: In reflex syncope, the documentation of bradycardia/asystole during a syncopal episode does not rule out the possibility that a preceding or parallel hypotensive reflex plays an important role. Similarly, even when a hypotensive mechanism is established, the possibility of an associated cardioinhibitory reflex should be investigated. Investigating the mechanism of reflex syncope is mandatory in patients with severe recurrent episodes, with the final aim to develop a personalized treatment strategy. Recent trials have demonstrated the benefits of personalized mechanism-based therapy, thus highlighting the importance of a comprehensive assessment of the mechanisms underlying syncope.
(Less)
- author
- Brignole, Michele
; Rivasi, Giulia
; Fedorowski, Artur
LU
; Ståhlberg, Marcus
; Groppelli, Antonella
and Ungar, Andrea
- publishing date
- 2023-02-22
- type
- Contribution to journal
- publication status
- published
- in
- Expert Review of Medical Devices
- volume
- 20
- issue
- 2
- pages
- 109 - 119
- publisher
- Expert Reviews
- external identifiers
-
- pmid:36814102
- scopus:85149176495
- ISSN
- 1745-2422
- DOI
- 10.1080/17434440.2023.2174428
- language
- English
- LU publication?
- no
- id
- bebd591e-2f93-4e04-92ef-aa26d13bb442
- date added to LUP
- 2023-02-24 16:28:31
- date last changed
- 2025-07-29 03:57:11
@article{bebd591e-2f93-4e04-92ef-aa26d13bb442,
abstract = {{<p>INTRODUCTION: Treatment efficacy of reflex syncope is mainly related to the mechanism underlying syncope rather than its etiology or clinical presentation. The predominant mechanism underlying reflex syncope can be assigned to hypotensive or to bradycardic phenotypes.</p><p>AREAS COVERED: Methodology and diagnostic criteria of the most useful tests for the identification of hypotensive and bradycardic phenotypes are discussed. Diagnostic tests for the hypotensive phenotype include office blood pressure measurement with active standing test, home, and wearable blood pressure monitoring, 24-h ambulatory blood pressure monitoring and tilt table test. Diagnostic tests for the bradycardic phenotype include carotid sinus massage, tilt table test and prolonged ECG monitoring.</p><p>EXPERT OPINION: In reflex syncope, the documentation of bradycardia/asystole during a syncopal episode does not rule out the possibility that a preceding or parallel hypotensive reflex plays an important role. Similarly, even when a hypotensive mechanism is established, the possibility of an associated cardioinhibitory reflex should be investigated. Investigating the mechanism of reflex syncope is mandatory in patients with severe recurrent episodes, with the final aim to develop a personalized treatment strategy. Recent trials have demonstrated the benefits of personalized mechanism-based therapy, thus highlighting the importance of a comprehensive assessment of the mechanisms underlying syncope.</p>}},
author = {{Brignole, Michele and Rivasi, Giulia and Fedorowski, Artur and Ståhlberg, Marcus and Groppelli, Antonella and Ungar, Andrea}},
issn = {{1745-2422}},
language = {{eng}},
month = {{02}},
number = {{2}},
pages = {{109--119}},
publisher = {{Expert Reviews}},
series = {{Expert Review of Medical Devices}},
title = {{Tests for the identification of reflex syncope mechanism}},
url = {{http://dx.doi.org/10.1080/17434440.2023.2174428}},
doi = {{10.1080/17434440.2023.2174428}},
volume = {{20}},
year = {{2023}},
}