Download full-text


Available from: Andrew Krahn, Sep 26, 2015
145 Reads
  • Source
    • "január közötti időszakból az összes olyan eset adatait elemeztük, ahol a syncope etiológiájának vizsgálata keretében implantálható loop recorder (ILR) beültetésére került sor. Syncopeként értékeltük a hirtelen kezdetű, néhány perc alatt maradéktalanul rendeződő, összeeséssel járó eszméletvesztést [7]. A kivizsgálási stratégia a kezelőorvosok hatáskörében az érvényes nemzetközi ajánlásokhoz igazodott, az ILR alkalmazása tekintetében lényegesen befolyásolva a vizsgálati módszer korlátozott hozzáférhetősége által. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Extension of electrocardiographic monitoring via loop recorder implantation may increase the diagnostic yield of syncope work-up. In this retrospective observational study, the authors wanted to evaluate the diagnostic performance of implantable loop recorder in the everyday clinical practice. The authors analyzed the electronically stored data of all patients who underwent loop recorder implantation between 2005 and 2014 in their cardiology department because of recurrent syncope of undetermined origin. There were 52 loop recorder implantations within the study period. During the 167 (±136) days of monitoring, 36 (69.2%) diagnostic events occurred. In two-thirds of events, (46.2% of all monitored patients) a specific arrhythmia diagnosis was reached, allowing definitive treatment in these cases. In this selected population, there was no correlation between age, presence of known high-risk predictors, or accompanying trauma, and the mechanism of syncope. The high diagnostic rate of implantable loop recorder in the everyday clinical practice is in accordance with the findings in prospective clinical studies. This observation supports the early application of loop recorder in the diagnostic algorithm of syncope. Orv. Hetil., 2015, 156(15), 609-613.
    Orvosi Hetilap 04/2015; 156(15-15):609-613. DOI:10.1556/OH.2015.30124
  • Source
    • "Adenosine (AD) and adenosine triphosphate (ATP) administrations have long been proposed as potentially useful non-invasive diagnostic tools in patients with neurally-mediated or bradycardia-related syncope [2]. No consensus however has been reached in their use as study results have been inconclusive [1]. This article summarizes recent and past evidence in the use of both compounds in the diagnostic workup of patients with syncope and highlights the future perspectives of these agents in everyday clinical practice. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Syncope is a significant source of cardiovascular-related morbidity yet the etiology is frequently obscure and the identification of patients at highest risk is challenging. Adenosine (AD) and adenosine triphosphate (ATP) administrations have been suggested as potentially useful non-invasive tools in the diagnostic workup of patients with neurally-mediated or bradycardia-related syncope. It has been postulated that both compounds by modulating the autonomic innervation in the heart and exerting negative chronotropic and dromotropic effects in the conduction system, may unmask the mechanism of syncope. However, the clinical implications derived from the efficacy of both tests in the investigation of syncope remain unclear mainly due to inconclusive and occasionally contradictory results of published studies. This review article summarizes recent and past information in the use of ATP and AD in the investigation of syncope with emphasis on clinical trials. We present the current level of evidence for the use of these agents in clinical practice, identify areas where further research is warranted and highlight the future perspectives of these agents as complements to an accurate risk-stratification of patients with syncope. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Cardiology 01/2015; 183C:267-273. DOI:10.1016/j.ijcard.2015.01.089 · 4.04 Impact Factor
  • Source
    • "The fundamental pathophysiological mechanism underlying OH may be the impairment of systemic vascular resistance during standing, resulting in pooling of blood distally, leading to hypotension [3]. The term “idiopathic OH” was first used to describe patients who had OH, regardless of other conditions [28]; however, various autonomic dysfunctions could be combined in patients with OH, including bowel, sudomotor, thermoregulatory, and sexual [4]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We performed this study to determine whether electrocardiographic corrected QT (QTc) interval predicts alterations in sympathovagal balance during orthostatic intolerance (OI). We reviewed 1,368 patients presenting with symptoms suggestive of OI who underwent electrocardiography and composite autonomic function tests (AFTs). Patients with a positive response to the head-up tilt test were classified into orthostatic hypotension (OH), neurocardiogenic syncope (NCS), or postural orthostatic tachycardia syndrome (POTS) groups. A total of 275 patients (159 OH, 54 NCS, and 62 POTS) were included in the final analysis. Between-group comparisons of OI symptom grade, QTc interval, QTc dispersion, and each AFT measure were performed. QTc interval and dispersion were correlated with AFT measures. OH Patients had the most severe OI symptom grade and NCS patients the mildest. Patients with OH showed the longest QTc interval (448.8±33.6 msec), QTc dispersion (59.5±30.3 msec) and the lowest values in heart rate response to deep breathing (HRDB) (10.3±6.0 beats/min) and Valsalva ratio (1.3±0.2). Patients with POTS showed the shortest QTc interval (421.7±28.6 msec), the highest HRDB values (24.5±9.2 beats/min), Valsalva ratio (1.8±0.3), and proximal and distal leg sweat volumes in the quantitative sudomotor axon reflex test. QTc interval correlated negatively with HRDB (r = -0.443, p<0.001) and Valsalva ratio (r = -0.425, p<0.001). We found negative correlations between QTc interval and AFT values representing cardiovagal function in patients with OI. Our findings suggest that prolonged QTc interval may be considered to be a biomarker for detecting alterations in sympathovagal balance, especially cardiovagal dysfunction in OH.
    PLoS ONE 09/2014; 9(9):e106417. DOI:10.1371/journal.pone.0106417 · 3.23 Impact Factor
Show more