Twenty-five years of research on syncope

Figures

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  Figure 1. Graphical representation of the manuscripts related to syncope published in Europace from its foundation. ICD, implantable cardioverter defibrillator; CRT, cardiac resynchronization therapy; ILR, implantable loop recorder; ECG, electrocardiogram; EPS, electrophysiological study; CSM, carotid sinus massage.

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  Figure 2. Main reflex syncope triggers and mechanisms.# Reflex syncope may be triggered by orthostatic challenge and hypotension, central stimuli such as emotional stress or blood sight, gastrointestinal symptoms (nausea), or pain. The efferent arm of vasovagal reflex is composed of vasodepressive component, usually preceding the cardioinhibitory component mediated by vagal activation and leading to profound bradycardia or asystole. Recent studies have identified a steep increase in epinephrine and vasopressin during tilt testing as both compensatory responses to haemodynamic instability and hypothetical reflex triggers. Moreover, a specific haemodynamic profile of VVS patients has been identified and is characterized by lower systolic and higher diastolic BP, lower pulse pressure, and presence of asymptomatic BP drops on 24- h ambulatory BP monitoring.

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  Figure 3. Diagnostic workup of syncope. Reproduced with permission.37 ECG, electrocardiogram; EP study, electrophysiological study; CV, cardiovascular; SCD, sudden cardiac death.

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  Figure 4. Diagnostic flow chart for the identification of hypotensive and bradycardic phenotypes. Reproduced with permission.37 BP, blood pressure; ABPM, ambulatory blood pressure monitoring; HBPM, home blood pressure monitoring; CSM, carotid sinus massage; ILR, implantable loop recorder.