A13-1 Changes of cerebral blood flow during tilt table test in patients with vasovagal syncope

EP Europace, Dec 2003

Lorincz, I., Varga, E., Barta, K., Szabo, Z., Olah, L., Csiba, L.

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A13-1 Changes of cerebral blood flow during tilt table test in patients with vasovagal syncope

B G.A. Ruiz 0 1 2 3 4 J.C. Perfetto 0 1 2 3 4 R. Chirife 0 1 2 3 4 R. Gelpi. Hospital De Agudos Juan A Fernandez 0 1 2 3 4 Buenos Aires 0 1 2 3 4 Argentina 0 1 2 3 4 Medical 0 1 2 3 4 Europace Supplements, 0 I. Lorincz, L. Olah', E. Varga, K. Barta, Z. Szabo, L. Csiba'. First Department 1 W. Mojkowski, M. Moszczenski, M. Tomaszewska-I&cam , W. Braksator, .I. Krol, M. Dluzniewski. Dept 2 J. Gajek, D. Zysko. Department Wroclaw , Wroclaw , Poland 3 M.C. Tentori , De hgenieria 4 A. Guillardot , Facultad A 1 3 . T I L T T E S T I N G IN V A S O - V A G A L S Y N C O P E : N E W A S P E C T S NFB BE1 W beats PFBlndex W beats FF Index W beats Ramp Index TC effective 16 T Cn o n e f f e c t1 2 EC effect. 10 EC noneff 2 TC effective TC noneffect EC effect. EC noneff * p<o,o5,** p<o,oo1, IVS cm ‘1,l '1,33 1,33 12 EFW W ”) 54(6,4) 50 (9,6) 48 45 BMI Kg/m2 (+S”) 27,5 (3,s) 26,9 (1,5) '25,5 '32,5 % Mean total energy J Mean imulse energy J (+SD W ”) "30,6 (14,Z) 66,66 (19,Z) "220 335 "20,9 (13,l) 39,5 (15,4) "160 200 I Al 2 6 W H I C H F A C T O R S D E T E R M I N A T E T H E EFFICACY O F L O W E N E R G Y T R A N S E S O P H A G E A L CARDIOVERSION O F P A R O X Y S M A L ATRIAL FIBRILLATION The aim of the study was to evaluate which factors contribute to successful low energy tramesophageal cardioversion (TC) of paroxysmal atria1 fibrillation. The study group consists of 28 patients (20M, SF) with atria1 fibrillation of sudden onset (<24h), age 32-87, without hyperthyroid@ treated with beta-blockers. TC with energy of 5, 10, 15, 20,30,50 J was delivered between 4 coil (app. 15 cm’) esophageal single use electrode as cathode, placed using the Roth’s rule and external electrode in V1 as anode using biphasic impulse. When TC was not effective the conventional external cardioversion (EC) was performed with energy of 50, 100, 120, 200 J with the same impulse formation. Body rims index (BMI), left atria1 (LA), left ventricular (Lv), and intravetricular septum (IVS) diameter, and ejection fraction (EF) were evaluated in each patient. Results are shown in the table below. No of pat Age mean &SD) LA cm &SD) L” cm (+SD) Conclusion: 1. Tramesophageal low energy cardioversion is effective procedure, but less than conventional one. 2. BMI and patient’s weight have the biggest influence on success of TC. 3. Left ventricular hypertmphy diminishes TC efficacy. I Al 3 1 C H A N G E S O F C E R E B R A L T A B L E T E S T IN PATIENTS S Y N C O P E B L O O D W I T H F L O W DURING V A S O V A G A L TILT Objectives: Vasovagal syncope (VVS) IS a common and complex clinical disorder, but the underlying pathological mechanisms have not completely demonstrated. Although recent research has clariiied some of the pathophysiological mechanisms involved, it still remains unknown or incompletely understood. The cerebrovascular changes that occur prior to VVS are unclear, with both increases and decreases in cerebrovascular resistance being reported during VVS. Aim: Tramcranial Doppler sonography was used to assess time relation and characteristically changes in middle cerebral artery blood flow velocity and pulsatiliy index before and during syncope provoked by head up tilt test (HUq in patient with VVS. Patients a n d Methods: We performed tilt table tests in 18 patients (age:42+/13 ys, 1216 female/male) with a medical history for syncope after exclusion of neurologic and cardiologic diseases. Examination was done 45 minutes drug free HUTT in a 60 degrees postural position under monitoring of electrocardiogram, beat to beat blood pressure monitoring (PORTAPRESS) and measurements of pulsatility index and blood flow velocity of middle cerebral artery (systolic, middle and diastolic) by transcranial Doppler with ~-MHZ probe(DWL Multi-Dop X4). Results: In patients with VVS syncope occurred after 5 to 45 min (average 23.3). During HU’IT 3 had cardioinhibitory (CI), 9 vasodepressor (VD) and 6 with mixed (MX) type of VVS. The mean systolic blood pressure decreased from the initial value of 140&19 to 70&28 mmHg during syncope. Par&II to IDENTIFICATION O F NEGATIVE F E E D B A C K A N D F E E D F O W A R D TILT T E S T IN Y O U N G W O M E N F E E D B A C K , The sequential analysis allows to identify both baroreflex and non-baroreflex sequences. In order to assess the distribution of these sequences during Head-up tilt test (‘IT), 26 young women were studied, 13 with a positive tilt test (‘IT+, 23.6&6.3 yr.) and 13 with a negative one (‘IT, 24.6&4 yr.). Using continuous blood pressure (BP) and RR interval records, the following sequences were detected: 1) parallel increase or decrease of BP and RR (negative feed back, NFB) during ~3 beats, 2) opposite direction of BP and RR changes (?BP precedes ?RR, positive feed back, PFB), 3) opposite direction of BP and RR changes (?RR precedes ?BP, feed forward, FF), 4) Isolated BP ramps with no changes in RR (RBP), under baseline conditions (B) and during the ‘IT (the first 5 min. and then every 10 min, plus 5 min pmsyncope and 10 min post-syncape in ‘IT+ pts). Of the total number of BP ramps, the percentages corresponding to NFB (BEI), PFB(PFBI), FF(FF1) and RBP(RI), as well as the percentage of beats involved in each sequence were calculated. ‘IT+ and ‘IT pts were compared. Results: Results are presented in the table. During ‘IT, BE1 decreases in pts with both ‘IT+ and ‘IT The PFBI+ (BP increase-tachycardia) increased signiiicantly only in pts with ‘IT In ‘IT+ pts the FFI decreased (FF+ B: 57.6, TIT 42, p<O.O5, FF- B: 59, Tl? 46) and the RI increased (B=12.2, 5’=24.8, p<O.O5, ps35.6, p<O.OOl). Sequence distribution of all patients (lndex*lOO) Baseline I Conclusion: Most of the BP changes are coupled to the cardiac rhythm either as baroreflex or non-baroreflex sequences. In pts with ‘IT+ there is a significant decrease in baroreflex activity, in sequences related to mechanicalhemodynamic effects and in the coupling between BP and the RR interval during TT T H E D I F F E R E N T T Y P E O F N E U R O H U M O R A L R E S P O N S E IN T H E C O U R S E O F V A S O V A G A L S Y N C O P E DURING T H E PASSIVE A N D ACTIVE P H A S E O F T H E HEAD-UP TILT T E S T The mechanism regulating adrenomedullin (ADM) secretion-a strong vasodilating peptide - are poorly understood. The activation of sympathetic nervous system causes rise of blood pressure due to increase of peripheral vascular resistance, what can be the impulse for A D M secretion. Aim: The aim of the study was to assess the relation between the activation of autonomic nervou system during the passive phase of head-up tilt test (HUq using HRV B parameter, the stage of the test in whom the syncape occurred and the change of adrenomedullin level as compared to baseline values. Material a n d methods: Study group consisted of 23 patients, aged 44,5&14,1 years (18F and 6M), in whom HU’IT was done according to the Italian protocol and syncope due to cardiodepressive reaction was observed. There were 17 pts with syncope after the NTG provocation (group I) and 6 pts with syncope during the passive phase of HU’IT (group II). Adrenomedullin plasma level was assessed using radioimmunological assay, in baseline condi


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Lorincz, I., Varga, E., Barta, K., Szabo, Z., Olah, L., Csiba, L.. A13-1 Changes of cerebral blood flow during tilt table test in patients with vasovagal syncope, EP Europace, 2003, B19, DOI: 10.1016/S1099-5129(03)91573-X