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- Brignole, Michele, et al.
(författare)
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Clinical controversy : methodology and indications of cardioneuroablation for reflex syncope
- 2023
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Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - 1532-2092. ; 25:5, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- In 2005, Pachon et al.1 proposed cardiac vagal denervation to treat neurally mediated syncope. Since then, a metanalysis of observational studies2 and a recent randomized controlled trial (RCT)3 have provided some evidence that cardioneuroablation (CNA) is able to prevent syncope recurrence at least during the first 2 years following the procedure in patients affected by reflex syncope. In brief, the recent metanalysis2 of 14 studies including a total of 465 patients reported an average freedom of syncopal recurrence in 92% of patients (95% confidence interval 88–95%) during follow-up. The only available open RCT3 reported 8% recurrence of syncope in the 24 patients randomized to CNA and 54% recurrence rate in 24 untreated controls (P = 0.0004) during 2-year follow-up. In all studies, after the ablation procedure, the patients demonstrated heart rate increase together with reduction of heart rate variability (indicating impaired parasympathetic stimulation of the heart) persisting at least for 2 years. This provides proof-of-concept for the modification of the vagal ganglia activity in the heart.Given these facts, it is likely that CNA will become increasingly popular among physicians caring for syncope patients in the years to come. Nevertheless, many issues concerning clinical indications, methodology, and long-term results remain unresolved. These issues constitute the background of this manuscript in which leaders in CNA and experts in syncope debated critical issues and aimed to find agreement and, if not possible, to highlight the controversies that could be addressed in future studies. The authors were initially requested to give their evidence-based opinion on several predefined motions. These were merged into a manuscript draft, which was subsequently critically revised by means of two rounds of comments.
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- Fedorowski, Artur, et al.
(författare)
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Twenty-five years of research on syncope
- 2023
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Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - 1532-2092. ; 25:8, s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- Over the last 25 years, the Europace journal has greatly contributed to dissemination of research and knowledge in the field of syncope. More than 400 manuscripts have been published in the journal. They undoubtedly improved our understanding of syncope. This symptom is now clearly differentiated from other forms of transient loss of consciousness. The critical role of vasodepression and/or cardioinhibition as final mechanisms of reflex syncope is emphasized. Current diagnostic approach sharply separates between cardiac and autonomic pathways. Physiologic insights have been translated, through rigorously designed clinical trials, into non-pharmacological or pharmacological interventions and interventional therapies. The following manuscript is intended to give the reader the current state of the art of knowledge of syncope by highlighting landmark contributions of the Europace journal.
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- Garcia Gonzalez, Vanessa, 1979-
(författare)
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(Dis)engaging in moving-body practices : physical activity correlates among university students in Mexico
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study was to gather in-depth data to provide insights into individual, social and environmental correlates of physical activity in order to identify priority elements to design feasible and effective intervention strategies to promote regular physical activity engagement among university students in a middle-income country such as Mexico. The situation of university students (dis)engaging in moving-body practices was explored through the use of a survey based on the Global Physical Activity Questionnaire and the construction of Moving-body diaries that included visual and verbal narratives. The survey was conducted among first and fourth year students (2015, n=1046) from three different universities. Significant predictors (p < .05) were evaluated using logistic regression. Additionally, eleven students from three universities created Movingbody diaries, framing and narrating their physicalities in their social worlds. We used the situational analysis theory-method package to analyze the qualitative data. Findings showed that 8.5% of students did not meet WHO recommendations on physical activity, while, 39.7% of students did not participate in vigorous-intensity PA. Results revealed that male students, and female students who were working and studying were more likely to meet WHO recommendations on PA; while, University B students were less likely than those in University A to meet guidelines. Findings based on visual and verbal narratives indicate the existence of other factors affecting university students’ physical activity practices, such as: individual life projects and aspirations for social mobility, the process of growing up, lack of time, being tired, enjoyment of a moving-body practice, body image, desire to lose weight, health concerns, being supported by significant others, safety concerns, lack of money, bad weather and lack of accessible facilities and activities. Findings indicate that intervention strategies using multilevel approaches across social worlds, aiming to promote a moving-body culture may be most effective
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- Montoya, Oscar Danilo, et al.
(författare)
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Reduction of Annual Operational Costs in Power Systems through the Optimal Siting and Sizing of STATCOMs
- 2021
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Ingår i: Applied Sciences. - : MDPI AG. - 1454-5101 .- 2076-3417. ; 11:10, s. 4634-
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Tidskriftsartikel (refereegranskat)abstract
- The problem of the optimal siting and placement of static compensates (STATCOMs) in power systems is addressed in this paper from an exact mathematical optimization point of view. A mixed-integer nonlinear programming model to present the problem was developed with the aim of minimizing the annual operating costs of the power system, which is the sum of the costs of the energy losses and of the installation of the STATCOMs. The optimization model has constraints regarding the active and reactive power balance equations and those associated with the devices’ capabilities, among others. To characterize the electrical behavior of the power system, different load profiles such as residential, industrial, and commercial are considered for a period of 24 h of operation. The solution of the proposed model is reached with the general algebraic modeling system optimization package. The numerical results indicate the positive effect of the dynamic reactive power injections in the power systems on annual operating cost reduction. A Pareto front was built to present the multi-objective behavior of the studied problem when compared to investment and operative costs. The complete numerical validations are made in the IEEE 24-, IEEE 33-, and IEEE 69-bus systems, respectively.
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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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| 9. |
- Sutton, Richard, et al.
(författare)
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Tilt testing remains a valuable asset
- 2021
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X.
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Forskningsöversikt (refereegranskat)abstract
- Head-up tilt test (TT) has been used for >50 years to study heart rate/blood pressure adaptation to positional changes, to model responses to haemorrhage, to assess orthostatic hypotension, and to evaluate haemodynamic and neuroendocrine responses in congestive heart failure, autonomic dysfunction, and hypertension. During these studies, some subjects experienced syncope due to vasovagal reflex. As a result, tilt testing was incorporated into clinical assessment of syncope when the origin was unknown. Subsequently, clinical experience supports the diagnostic value of TT. This is highlighted in evidence-based professional practice guidelines, which provide advice for TT methodology and interpretation, while concurrently identifying its limitations. Thus, TT remains a valuable clinical asset, one that has added importantly to the appreciation of pathophysiology of syncope/collapse and, thereby, has improved care of syncopal patients.
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