Article
Cardiac & Cardiovascular Systems
Pietro Palmisano, Federico Guerra, Vittorio Aspromonte, Gabriele Dell'Era, Pier Luigi Pellegrino, Mattia Laffi, Carlo Uran, Silvana De Bonis, Michele Accogli, Antonio Dello Russo, Giuseppe Patti, Francesco Santoro, Antonella Torriglia, Gerardo Nigro, Antonio Bisignani, Giovanni Coluccia, Giulia Stronati, Vincenzo Russo, Ernesto Ammendola
Summary: Empiric pacemaker implantation significantly reduces the risk of syncope recurrence compared to ILR monitoring in patients with unexplained, recurrent, traumatic syncope and bifascicular block.
Article
Cardiac & Cardiovascular Systems
Vincenzo Russo, Anna Rago, Nicola Grimaldi, Raffaele Chianese, Aniello Viggiano, Giuliano D'Alterio, Diego Colonna, Agostino Mattera Iacono, Andrea Antonio Papa, Andrea Spadaro Guerra, Alessio Gargaro, Antonio Rapacciuolo, Berardo Sarubbi, Antonio D'Onofrio, Gerardo Nigro
Summary: This study evaluated the effect of remote monitoring (RM) in patients with unexplained syncope, and found that compared to regular in-office follow-up visits, RM increased the chance of detecting clinically relevant arrhythmias.
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2023)
Article
Medicine, General & Internal
Ekrem Yasa, Theodoros Intzilakis, Fabrizio Ricci, Olle Melander, Viktor Hamrefors, Richard Sutton, Artur Fedorowski
Summary: The objective of this study was to explore the outcomes of primary vs. delayed implantable cardiac monitors (ILR) implantation after an initial syncope evaluation. The study found that primary ILR implantation was associated with more positive results from cardiovascular autonomic testing (CAT) compared to delayed ILR implantation. However, there were no differences between the two groups in terms of negative ILR monitoring and pacemaker implantations.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Medicine, General & Internal
Madeleine Johansson, Cecilia Rogmark, Richard Sutton, Artur Fedorowski, Viktor Hamrefors
Summary: Middle-aged individuals hospitalized due to unexplained syncope and orthostatic hypotension have an increased risk of subsequent fractures.
Editorial Material
Cardiac & Cardiovascular Systems
Fabian Leys, Alessandra Fanciulli
Summary: This editorial discusses the association between hypotension and reflex syncope, based on the findings of the SynABPM 1 study.
EUROPEAN HEART JOURNAL
(2022)
Article
Cardiac & Cardiovascular Systems
Victor Neira, Andres Enriquez, Robert Sheldon, Matthew G. Hanson, Connor Maxey, Adrian Baranchuk
Summary: This study aimed to determine whether QRS morphology or other electrocardiographic characteristics could identify patients who may benefit from permanent pacing. The study found that regardless of the type of bundle branch block or the presence of PR interval prolongation, pacemaker implantation reduced adverse events compared to implantable loop recorder monitoring in patients with syncope and bifascicular block.
Article
Cardiac & Cardiovascular Systems
Richard J. Czosek, Huaiyu Zang, Shankar Baskar, Jeffrey B. Anderson, Timothy K. Knilans, Nicholas J. Ollberding, David S. Spar
Summary: Evaluation of implantable loop recorders (ILR) in pediatric patients showed high efficacy and support for clinical management. ILR efficacy was similar regardless of indication, although patients with nonsyncope indications had a higher frequency of ventricular arrhythmias. Most arrhythmic findings occurred within the first 12 months, suggesting the potential value of new technology for less invasive monitoring for 6 to 12 months.
AMERICAN JOURNAL OF CARDIOLOGY
(2021)
Article
Cardiac & Cardiovascular Systems
Helen Eftekhari, Hejie He, James Doug Lee, Geeta Paul, Albiona Zhupaj, Thomas Lachlan, Michael Kuehl, Tarv Dhanjal, Sandeep Panikker, Shamil Yusuf, Sajad Hayat, Faizel Osman
Summary: Nurse-led implantable loop recorders (ILRs) are safe and effective in achieving symptom-rhythm correlation. Nurse-led syncope clinics have a significant impact on management compared to physician-led clinics. Larger prospective studies are needed to evaluate their long-term impact.
Article
Peripheral Vascular Disease
William B. Earle, Jordan K. Kondo, Karla N. Kendrick, Ruth-Alma Turkson-Ocran, Long Ngo, Jennifer L. Cluett, Kenneth J. Mukamal, Natalie Daya Malek, Elizabeth Selvin, Pamela L. Lutsey, Josef Coresh, Stephen P. Juraschek
Summary: This study compares the long-term clinical consequences of supine hypertension and standing hypotension among middle-aged adults.
Article
Cardiac & Cardiovascular Systems
Michele Brignole, Vincenzo Russo, Francesco Arabia, Mario Oliveira, Alonso Pedrote, Arnaud Aerts, Antonio Rapacciuolo, Serge Boveda, Jean Claude Deharo, Giampiero Maglia, Gerardo Nigro, Daniele Giacopelli, Alessio Gargaro, Marco Tomaino
Summary: In patients aged 40 years or older with severe recurrent reflex syncope and tilt-induced asystole, a dual-chamber pacemaker with closed loop stimulation is highly effective in reducing the recurrence of syncope. The inclusion of tilt testing is supported as a useful method to select candidates for cardiac pacing.
EUROPEAN HEART JOURNAL
(2021)
Article
Cardiac & Cardiovascular Systems
Carlo Fumagalli, Martina Rafanelli, Michele Brignole, Caterina Guarducci, Niccolo Bettoni, Giulia Rivasi, Paolo Pieragnoli, Giuseppe Ricciardi, Luca Checchi, Marco Gambardella, Flavia Casolaro, Giuseppe Paolisso, Raffaele Marfella, Giuseppe Signoriello, Niccolo Marchionni, Andrea Ungar, Celestino Sardu
Summary: This retrospective study reviewed 55 patients with syncope and bifascicular block (BFB) who received implantable cardiac monitors (ICM) from 2012 to 2020. The results showed that 36.3% of patients experienced syncope during follow-up, with 10.9% classified as arrhythmic syncope, and the incidence of syncope increased with age. 14 patients (25.5%) underwent pacemaker implantation, which was more frequent in patients aged 75 years and older.
INTERNATIONAL JOURNAL OF CARDIOLOGY
(2023)
Article
Health Care Sciences & Services
Kevin Willy, Christian Ellermann, Sarah Syring, Benjamin Rath, Florian Reinke, Daniela Willy, Julian Wolfes, Felix K. Wegner, Lars Eckardt, Julia Kobe, Nexhmedin Morina
Summary: This study aimed to analyze the potential role of psychological factors on the recurrence of arrhythmic or non-arrhythmic syncopes. The results showed that patients with non-arrhythmic syncopes had higher levels of anxiety and depression, and lower quality of life.
JOURNAL OF PERSONALIZED MEDICINE
(2022)
Article
Peripheral Vascular Disease
Nasia Sheikh, Aaron A. Phillips, Shaun Ranada, Matthew Lloyd, Karolina Kogut, Kate Bourne, Juliana G. Jorge, Lucy Y. Lei, Robert S. Sheldon, Derek Exner, Mary Runte, Satish R. Raj
Summary: Initial orthostatic hypotension (IOH) is defined as a large drop in blood pressure within 15 seconds of standing. This study investigated the effects of sympathetic activation and involuntary muscle contraction on IOH. The results showed that sympathetic activation mitigated the blood pressure response in IOH, while involuntary muscle contraction mitigated the blood pressure response and reduced symptoms.
Article
Cardiac & Cardiovascular Systems
Robert Sheldon, Mario Talajic, Anthony Tang, Giuliano Becker, Vidal Essebag, Omar Sultan, Adrian Baranchuk, Debbie Ritchie, Carlos Morillo, Andrew Krahn, Michele Brignole, Braden Manns, Connor Maxey, Satish R. Raj
Summary: This study aimed to compare the effectiveness of empiric permanent pacing with acting on the results of an implantable cardiac monitor (ICM) for the care of patients with bifascicular block. The results showed that empiric permanent pacing reduced major adverse events but did not reduce syncope episodes.
JACC-CLINICAL ELECTROPHYSIOLOGY
(2022)
Review
Clinical Neurology
Diogo Reis Carneiro, Isabel Rocha, Mario Habek, Raimund Helbok, Johann Sellner, Walter Struhal, Gregor Wenning, Alessandra Fanciulli
Summary: This study investigates the acute and mid-term effects of SARS-CoV-2 infection on cardiovascular autonomic function. It finds evidence of cardiovascular autonomic dysfunction during and after COVID-19, including reflex syncope and postural orthostatic tachycardia syndrome. However, more data are needed to quantify the impact of these autonomic disorders on human health.
EUROPEAN JOURNAL OF NEUROLOGY
(2023)
Review
Cardiac & Cardiovascular Systems
Michele Brignole, Franco Cecchi, Aris Anastasakis, Lia Crotti, Jean Claude Deharo, Perry M. Elliott, Artur Fedorowski, Juan Pablo Kaski, Giuseppe Limongelli, Martin S. Maron, Iacopo Olivotto, Steve R. Ommen, Gianfranco Parati, Win Shen, Andrea Ungar, Arthur Wilde
Summary: Syncopal events in patients with hypertrophic cardiomyopathy (HCM) are vital considerations for risk stratification and ICD implantation, but the cause of syncope is often under-investigated or unexplained. Current syncope guidelines lack a detailed definition of unexplained syncope. To address this gap, an international panel of experts in syncope and HCM wrote a consensus document to provide practical guidance for the diagnosis and management of syncope in HCM patients.
INTERNATIONAL JOURNAL OF CARDIOLOGY
(2023)
Article
Cardiac & Cardiovascular Systems
Frederik Jorrit de Lange, Willem Petrus Merijn Emmanuel Hofland, Alessio Ferrara, Alessio Gargaro, Michele Brignole, Jan Gerrit van Dijk
Summary: In this study, a novel, practical, and inexpensive method called Open-Access-Video-TTT was described, which enables the addition of video recording during tilt table testing (TTT) without the need for an electroencephalogram (EEG) machine.
Article
Medicine, General & Internal
Vincenzo Russo, Erika Parente, Angelo Comune, Nunzia Laezza, Anna Rago, Paolo Golino, Gerardo Nigro, Michele Brignole
Summary: This study compared the positivity rate and type of responses in patients with classical and non-classical vasovagal syncope (VVS) using NTG-potentiated HUTT. The results showed that the positivity rate of HUTT was significantly higher in patients with classical VVS compared to those with non-classical VVS. Non-classical VVS patients were more likely to have a cardioinhibitory response and a history of traumatic syncope. Male sex, classical VVS, history of traumatic syncope, and use of diuretics were independent predictors of HUTT positivity.
EUROPEAN JOURNAL OF INTERNAL MEDICINE
(2023)
Correction
Cardiac & Cardiovascular Systems
Giuseppe Mascia, Lia Crotti, Antonella Groppelli, Marco Canepa, Andrea Carlo Merlo, Stefano Benenati, Paolo Di Donna, Roberta Della Bona, Davide Soranna, Antonella Zambon, Italo Porto, Iacopo Olivotto, Gianfranco Parati, Michele Brignole, Franco Cecchi
INTERNATIONAL JOURNAL OF CARDIOLOGY
(2023)
Review
Cardiac & Cardiovascular Systems
Michele Brignole, Tolga Aksu, Leonardo Calo, Philippe Debruyne, Jean Claude Deharo, Alessandra Fanciulli, Artur Fedorowski, Piotr Kulakowski, Carlos Morillo, Angel Moya, Brian Olshansky, Roman Piotrowski, Sebastian Stec, Dan Wichterle
Article
Cardiac & Cardiovascular Systems
Nicola Bottoni, Fabio Quartieri, Matteo Iori, Antonella Battista, Alessandro Navazio, Michele Brignole
Summary: This study analyzed the outcomes of AF ablation in patients from 2002 to 2021 at the cardiology department of Reggio Emilia hospital. The follow-up was conducted until the second half of 2022. The findings showed that despite one or more ablations, the long-term recurrence rate of symptomatic AF remained relatively high, but ablation was able to reduce the rate of symptomatic recurrences and delay their occurrence.
Article
Cardiac & Cardiovascular Systems
Vincenzo Russo, Erika Parente, Marco Tomaino, Angelo Comune, Antonella Sabatini, Nunzia Laezza, Domenico Carretta, Gerardo Nigro, Anna Rago, Paolo Golino, Michele Brignole
Summary: This study compared the effectiveness of the traditional nitroglycerin head-up tilt test (HUTT) and a shorter duration fast protocol in diagnosing cases of hypotension and bradycardia. The results showed that the fast protocol had a similar positivity rate and hemodynamic response distribution compared to the traditional protocol. Therefore, the fast protocol can be used as an alternative to the traditional protocol.
EUROPEAN HEART JOURNAL
(2023)
Article
Medicine, General & Internal
Ludovico Furlan, Pietro Di Francesco, Eleonora Tobaldini, Monica Solbiati, Giorgio Colombo, Giovanni Casazza, Giorgio Costantino, Nicola Montano
Summary: This study evaluates the CO2 emissions caused by the unwarranted variation in the use of MRI and CT scans among G20 countries, finding significant differences and substantial potential for emissions reduction.
EUROPEAN JOURNAL OF INTERNAL MEDICINE
(2023)
Review
Engineering, Biomedical
Michele Brignole, Giulia Rivasi, Artur Fedorowski, Marcus Stahlberg, Antonella Groppelli, Andrea Ungar
Summary: The efficacy of reflex syncope treatment is mainly related to its underlying mechanism rather than its cause or clinical presentation. This article discusses the methodology and diagnostic criteria of tests to identify hypotensive and bradycardic phenotypes. The importance of investigating the mechanism of reflex syncope is highlighted, particularly in patients with severe recurrent episodes, in order to develop a personalized treatment strategy.
EXPERT REVIEW OF MEDICAL DEVICES
(2023)
Editorial Material
Cardiac & Cardiovascular Systems
Alice Bernardelli, Filippo Dossi, Mario Raccis, Roberto Maggi, Michele Brignole, Guido Parodi
Summary: An asymptomatic 56-year-old man with type 2 Brugada pattern, inducible ventricular fibrillation, and family history of sudden cardiac death, who had an Implantable Cardioverter-Defibrillator implanted, was admitted to the hospital 17 years later due to palpitations related to atrial flutter. Unexpectedly, a transthoracic echocardiogram revealed clinically manifest hypertrophic cardiomyopathy.
JOURNAL OF ELECTROCARDIOLOGY
(2023)
Article
Cardiac & Cardiovascular Systems
Bashaaer Sharad, Giulia Rivasi, Viktor Hamrefors, Madeleine Johansson, Andrea Ungar, Richard Sutton, Michele Brignole, Gianfranco Parati, Artur Fedorowski
Summary: This study compared ambulatory blood pressure monitoring data between patients with reflex syncope and a control group. The findings showed that patients with reflex syncope had lower 24-hour systolic blood pressure, higher 24-hour diastolic blood pressure, and more frequent daytime drops in systolic blood pressure.
JOURNAL OF THE AMERICAN HEART ASSOCIATION
(2023)
Article
Cardiac & Cardiovascular Systems
Nicola Bottoni, Paolo Donateo, Luca Rossi, Michele Malagu, Luca Tomasi, Fabio Quartieri, Andrea Biagi, Matteo Iori, Giacomo Mugnai, Antonella Battista, Stefano Clo, Michele Brignole, Matteo Bertini
Summary: Using intracardiac echocardiography (ICE) during transseptal catheterization (TSC) procedures for supraventricular arrhythmias significantly reduces periprocedural complications and complications specifically related to TSC. ICE support is associated with a lower complication rate, demonstrating its importance in left atrial arrhythmia ablation procedures.
JOURNAL OF CARDIOVASCULAR DEVELOPMENT AND DISEASE
(2023)
Letter
Cardiac & Cardiovascular Systems
Michele Brignole
Article
Cardiac & Cardiovascular Systems
Vincenzo Russo, Erika Parente, Angelo Comune, Nunzia Laezza, Anna Rago, Gerardo Nigro, Michele Brignole
Summary: This study compared the clinical characteristics and response to head-up tilt test (HUTT) between situational syncope (SS) and vasovagal syncope (VVS). The results showed that compared to VVS, patients with SS have different clinical characteristics and a higher prevalence of hypotensive drugs. The positivity rate of HUTT is high and similar to that of VVS, although patients with SS show a higher prevalence of hypotensive responses.
Article
Peripheral Vascular Disease
Antonella Groppelli, Martina Rafanelli, Giuseppe Dario Testa, Samuele Agusto, Giulia Rivasi, Erika Carbone, Davide Soranna, Antonella Zambon, Paolo Castiglioni, Andrea Ungar, Michele Brignole, Gianfranco Parati
Summary: Compared with conventional methods, the study found that RootiRx (R) was unable to detect rapid drops in blood pressure occurring during impending reflex syncope, and thus cannot be used as a diagnostic tool for hypotensive syncope. However, the RRI mean values and LF/HF power ratios obtained with RootiRx (R) were consistent with those obtained using conventional methods.
JOURNAL OF HUMAN HYPERTENSION
(2023)
