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- Rivasi, Giulia, et al.
(författare)
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Syncope : new solutions for an old problem
- 2021
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Ingår i: Kardiologia Polska. - 1897-4279. ; 79:10, s. 1068-1078
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Tidskriftsartikel (refereegranskat)abstract
- Syncope is a frequent event in the general population. Approximately 1%-2% of all emergency department admissions are due to syncope and at least one third of all people experience fainting in their life. Although consequences of cardiac syncope are generally feared, non-cardiac syncope is much more common and may be associated with severe injuries and quality of life impairment, particularly in older adults. Various diagnostic and therapeutic strategies have been created and implemented over decades, leading to significant improvements in diagnostic accuracy and treatment effectiveness. In recent years, diagnosis and treatment have further evolved according to an innovative approach focused on the hemodynamic mechanism underlying syncope, based upon the assumption that knowledge of syncope mechanism is a prerequisite for effective syncope prevention and treatment. Therefore, a new classification of syncope has been proposed, which defines two main syncope phenotypes with different predominant mechanisms: the hypotensive phenotype, where hypotension or vasodepression prevails, and the bradycardic phenotype, where cardioinhibition prevails. Identification of syncope phenotype - bradycardic or hypotensive/vasodepressive - represents the first step towards a personalized management of syncope, characterized by customized interventions for prevention. The present review is aimed at illustrating these new developments in diagnosis and therapy of non-cardiac syncope within a mechanism-based perspective. Diagnosis and therapy of bradycardic and hypotensive phenotypes are discussed, with a focus on recent evidence.
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| 2. |
- Zyśko, Dorota, et al.
(författare)
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The importance of the longest R-R interval on 24-hour electrocardiography in mortality prediction in patients with atrial fibrillation
- 2021
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Ingår i: Kardiologia Polska. - 1897-4279.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Heart rate control in atrial fibrillation (AF) is typically assessed by 24-hour electrocardiography (ECG). There are scarce data on the use of 24-hour ECG parameters to predict mortality in AF.AIMS: We aimed to identify 24-hour ECG parameters that predict mortality in AF.METHODS: We enrolled 280 ambulatory patients (mean [SD] age, 72.0 [8.7] years; 57.9% men) with permanent or persistent AF. Data on mortality and pacemaker or defibrillator implantation during follow-up were collected. Predictors of mortality were assessed using the Cox proportional hazards model and C-statistic.RESULTS: Compared with survivors, 78 (28%) patients who died were older, more often had comorbidities, left bundle branch block (LBBB), reduced left ventricular ejection fraction, lower maximum heart rate, a higher number of ventricular extrasystoles, and the longest R-R interval below 2 seconds. Univariate analysis revealed higher mortality in patients with the longest R-R intervals below 2 seconds compared with those with the R-R intervals of 2 seconds or longer (P <0.001). Independent mortality predictors in the regression model included older age, renal failure, history of coronary intervention, chronic obstructive pulmonary disease, LBBB, and a high number (≥770) or absence of R-R intervals of at least 2 seconds. The area under curve (AUC) for mortality prediction increased after inclusion of ECG parameters 0.748 [95% CI, 0.686-0.810] vs 0.688 [95% CI, 0.618-0.758]; P = 0.02).CONCLUSIONS: A high number of R-R intervals longer than 2 seconds or their absence on 24-hour ECG may predict mortality in AF.
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