Diagnostic and therapeutic approach to cardioinhibitory reflex syncope: A complex and controversial issue

Publication date: Available online 13 December 2019Source: Revista Portuguesa de Cardiologia (English Edition)Author(s): Bruno M.L. Rocha, Rita V. Gomes, Gonçalo J.L. Cunha, Beatriz M.V. Silva, Rita Pocinho, Rui Morais, Inês Araújo, Cândida FonsecaAbstractSyncope is defined as a transient loss of consciousness due to global cerebral hypoperfusion and is one of the leading causes of emergency department admission. The initial approach should focus on excluding non-syncopal causes for loss of consciousness and risk stratification for a cardiac cause, in order to ensure an appropriate etiological investigation and therapeutic approach. Vasovagal syncope (VVS), the most common type of syncope, should be assumed once other causes are excluded. Pathophysiologically, the vasovagal reflex is the result of a paradoxical autonomic response, leading to hypotension and/or bradycardia. VVS has not been shown to affect mortality, but morbidity may be considerable in those with recurrent syncopal episodes. The management of VVS includes both non-pharmacological and pharmacological measures that act on various levels of the reflex arc that triggers the syncopal episode. However, most are of uncertain benefit given the scarcity of high-quality supporting evidence. Pacemaker therapy may be considered in recurrent refractory cardioinhibitory reflex syncope, for which it is currently considered a robust intervention, as noted in the European guidelines. Non-randomized and unblinded studies h...
Source: Revista Portuguesa de Cardiologia - Category: Cardiology Source Type: research