What is the clinical evidence from this study?

Study design: Case Report. Population: Vasovagal syncope (n=1). Intervention: Cardioneuroablation and midodrine. Primary outcome: Syncope recurrence.

February 1, 2018Journal of Atrial FibrillationOpen Access

Stepwise Approach to the Different Parts of Vasovagal Syncope in a Patient Undergoing Cardioneuro Ablation

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Key result

Sequential treatment with cardioneuroablation and midodrine successfully eliminated recurrent syncope episodes in a 30-year-old man with mixed vasovagal syncope over a 9-month follow-up.

Why the study?

Does midodrine prevent recurrent syncope in a patient with a vasodepressor response after cardioneuroablation for cardioinhibitory vasovagal syncope?

Population

A 30-year-old man with recurrent cardioinhibitory type vasovagal syncope with asystole (n=1).

Design

Case_report

Follow-up

9 months (after midodrine initiation)

Authors

TATolga AksuElectrophysiology

Discussion

Member takes

Implication

May support sequential cardioneuroablation and midodrine in mixed vasovagal syncope; hypothesis-generating and requires prospective confirmation.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Does midodrine prevent recurrent syncope in a patient with a vasodepressor response after cardioneuroablation for cardioinhibitory vasovagal syncope?

Population

A 30-year-old man with recurrent cardioinhibitory vasovagal syncope who underwent cardioneuroablation and subsequent midodrine therapy.

Intervention

Ganglionated plexi ablation (cardioneuroablation) followed by midodrine 5 mg/day for recurrent syncope.

Outcome

Recurrence of syncope and response to head-up tilt table test.

Cardioneuroablation may unmask a vasodepressor component in mixed vasovagal syncope, which can be effectively managed with midodrine.

Limitations

Passive phase of HUT lasted longer than 30 minutes, potentially causing false positive vasodepression.
Using atrioventricular nodal functional response to continuous HFS may not be sufficient to locate ganglionated plexi.
Lack of a method for extracardiac vagal effect evaluation at the end of the procedure.
No primary scientific evidence of direct association between vagal response during clinical syncope and parasympathetic response site in HFS.
Prolonged passive phase of head-up tilt test (>30 minutes) may raise the question of a false positive vasodepression.
Using an atrioventricular nodal functional response to continuous high frequency stimulation may not be sufficient to locate ganglionated plexi.
No primary scientific evidence of direct association between vagal response during clinical syncope and parasympathetic response site during electrophysiological study.

Cite This Study

Tolga Aksu (2018) conducted a case report in Vasovagal syncope (n=1). Cardioneuroablation and midodrine was evaluated on Syncope recurrence. Sequential treatment with cardioneuroablation and midodrine successfully eliminated recurrent syncope episodes in a 30-year-old man with mixed vasovagal syncope over a 9-month follow-up.

synapsesocial.com/papers/6a883d59aaaef52b1e4df7e8 https://doi.org/10.4022/jafib.1797

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Implication

May support sequential cardioneuroablation and midodrine in mixed vasovagal syncope; hypothesis-generating and requires prospective confirmation.

Stepwise Approach to the Different Parts of Vasovagal Syncope in a Patient Undergoing Cardioneuro Ablation

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Stepwise Approach to the Different Parts of Vasovagal Syncope in a Patient Undergoing Cardioneuro Ablation

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider