Cardioinhibitory reflex syncope. More recently, catheter-based cardiac autonomic modulation, or cardioneuroablation (CNA), has emerged as a novel therapy for reflex syncope, and positive results in small open-label cohort studies, and more The systematic review report “Pacing as a Treatment for Reflex-Mediated (Vasovagal, Situational, or Carotid Sinus Hypersensitivity) Syncope” is published in conjunction with this guideline. After adjustment for patient characteristics, the medium-term syncope recurrence risk of CI-VVS patients who underwent CNA was similar to that of a population of patients undergoing pacemaker implantation with a similar safety profile. Differentiation of syncope from seizure is challenging and has therapeutic implications. Tilt testing was only positive after administration of nitroglycerin in 69% of patients. New evidence from recent trials has changed medic … Reflex syncope, a common form of vasovagal syncope (VVS), is associated with vasodilatation, cardioinhibitory response or both. The treatment of VVS is Sep 1, 2019 · Abordagem diagnóstica e terapêutica da síncope reflexa cardio‐inibitória – A complexidade de um tema controverso Diagnostic and therapeutic approach to cardioinhibitory reflex syncope: A complex and controversial issue Mar 19, 2018 · The first is a reflex bradycardia, known as cardioinhibitory reflex syncope. This is the first randomized study documenting efficacy of CNA in patients with cardioinhibitory VVS. Reflex syncope Jun 29, 2022 · Definition – Reflex syncope is a condition in which a reflex response causes vasodilatation and/or bradycardia (which may not be profound but is nevertheless slower than appropriate for the falling blood pressure), leading to systemic hypotension and cerebral hypoperfusion with transient loss of consciousness (TLOC). Cardioneuroablation may obviate the Blood pressure decreases quickest when the heart suddenly stops pumping, which happens in arrhythmia and in severe cardioinhibitory reflex syncope. Nov 1, 1998 · In patients with cardioinhibitory syncope, a generalized high-amplitude EEG slowing in the theta range was noted at the onset of syncope, followed by a brain-wave amplitude increase and slowing in the delta range. Loss of consciousness starts about 8 s after the last heart beat and circulatory standstill occurs after 10–15 s. May 16, 2024 · Abstract Background Differentiation of syncope from seizure is challenging and has therapeutic implications. Recurrence of vasovagal syncope is an aggravating, reaching the rate of 69%. Specifically, although the finding of carotid sinus hypersensitivity may indeed indicate an exaggerated vagal tone that causes syncope, it may also be a chance association in a patient with syncope due to another cause. It is divided into three types: vasovagal, situational, and carotid sinus syndrome. Syncope is a common problem that many clinicians may encounter in various outpatient settings. However, the lack of multicenter, randomized trials prevents it from being included in bradyarrhythmia treatment guidelines. Pacing system malfunction, structural cardiac diseases, and tachyarrhythmias are rare mechanisms. 9% of emergency room visits. The current definition of carotid sinus syncope requires the reproduction of (pre) syncope, recognized by the patient itself, in addition to the documentation of abnormal cardioinhibitory and/or vasodepressor reflex, in agreement with the so-called method of symptoms. 23 These syndromes share with vasovagal syncope a triggering event stimulating Feb 27, 2024 · The precise factors that trigger the reflex response in cardioinhibitory vasovagal syncope and the variability in individual responses remain areas of ongoing investigation. [5][6][7][8][9][10][2] Before an affected person passes out, there may be sweating, a decreased ability to see, or ringing in the ears. Understanding the triggers of the Bezold-Jarisch reflex is crucial for managing and preventing its potentially harmful effects. Up to 70% of the paediatric population with reflex syncope is female. We report 3 such individuals, describing our strategies in diagnosis, investigation and treatment, particularly focusing on conservative management Aug 22, 2022 · Methods Study design and patient population The study was a prospective, open, controlled, randomized, investigator-initiated trial (Cardioneuroablation for Reflex Syncope [ROMAN]; NCT03903744) comparing CNA versus optimal nonpharmacologic therapy in patients with cardioinhibitory VVS. These patients can present cardioinhibitory Vasovagal syncope (VVS), the most common type of syncope, should be assumed once other causes are excluded. 1 Syncope typically results from a vasodepressor response (hypotension), a cardioinhibitory response (bradycardia) or a combination of both mechanisms. This survey aims to provide a comprehensive overview of current CNA utilization in Europe. The treatment of patients with reflex syncope is reviewed here, focusing on preventive measures. The patient tested positive for severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and Dec 5, 2020 · The benefit of cardiac pacing in patients with severe recurrent reflex syncope and asystole induced by tilt testing has not been established. Closed‐loop stimulation significantly reduced recurrent VVS events up to 80% when compared to conventional pacing. Nov 1, 2023 · The Bezold–Jarisch reflex (BJR), first described 2, 3 in 1867, is a cardioinhibitory reflex that is speculated to be mediated by vagal sensory neurons (VSNs) that also triggers syncope. It is associated with an autonomic imbalance in which vagal hyperactivity predominates, resulting in vasodilation or bradycardia or both, thereby producing a fall in global cerebral perfusion. So far, only one small, randomized study has been published assessing the effectiveness of this method in the treatment of reflex syncope. Apr 20, 2023 · In certain patients with frequent and burdensome cardioinhibitory reflex syncope, dual-chamber cardiac pacemakers seem to be beneficial. 6 While 60% of persons experience their first faint (syncope) at younger than 25 years of age, 10% to 15% have Reflex or neurally mediated syncope is the most common form of syncope in any setting and at all ages. The mechanism remains unexplained in >25% of Jun 1, 2023 · The vasovagal syncope (VVS), which is a form of reflex syncope, is the most common form of syncope. Apr 13, 2023 · In fact, the American and ESC guidelines recommend only cardiac pacing in the cardioinhibitory type (especially type 2B). 1 Although patients with the cardioinhibitory subtype might benefit from pacemaker therapy, current 2017 United States guidelines caution against the use of pacemaker therapy due to the lack of large, randomized Apr 6, 2023 · Observational studies and a recent randomized controlled trial have provided some evidence that cardioneuroablation (CNA) may prevent syncope recurrence in patients affected by cardioinhibitory reflex syncope during the first 2 years following the procedure. 1, 2 The distinction between Jul 25, 2024 · As a result, the cardioinhibitory reflex is inhibited, potentially reducing syncope episodes. The response is often mixed because of the variable contribution of both components. (b) Jun 24, 2024 · Introduction Neurocardiogenic syncope is common with a lifetime incidence of >35% with one-third of these individuals suffering significant psychological and physical injury. Keywords: bradycardia, closed‐loop stimulation, pacemaker, syncope Apr 6, 2023 · Observational studies and a recent randomized controlled trial have provided some evidence that cardioneuroablation (CNA) may prevent syncope recurrence in patients affected by cardioinhibitory reflex syncope during the first 2 years following the procedure. Syncope is a symptom in which transient loss of consciousness occurs as a consequence of a self-limited, spontaneously terminating period of cerebral hypoperfusion. The aetiology is unknown and epidemiological data is limited. Figure 2. 9 Sep 1, 2019 · Pacemaker therapy may be considered in recurrent refractory cardioinhibitory reflex syncope, for which it is currently considered a robust intervention, as noted in the European guidelines. There are usually precipitating factors and prodromes. 1 It is typically nonfatal, but if it recurs frequently, it can lead to injury and significantly affect quality of life. Jan 17, 2025 · Cardioneuroablation is a rapidly developing procedure for the treatment of vagally mediated bradyarrhythmias. Electrocardiogram monitoring during positional change revealed reflex syncope with cardioinhibitory response, exhibiting sinus bradycardia, subsequent asystole, and syncope. The predominant reflex may be bradycardia (cardioinhibitory type), vasodilatation (vasodepressor type), or both. It is associated with bradycardia (cardioinhibitory response) and/or hypotension (vasodepressor response), likely mediated by parasympathetic activation and sympathetic inhibition. The individual will simply report a fall – an important point in history taking. The environment in which syncope occurs can compromise life, and Cardiac pacing has been studied extensively in patients with reflex syncope over the past two decades. A condition in which neurally-mediated syncope occurs in which the blood pressure falls and heart rate falls. Jul 31, 2021 · Cardiac pacing has been studied extensively in patients with reflex syncope over the past two decades. Cardioinhibitory reflex syncope typically affects young patients where permanent pacing should be avoided whenever possible. 7%) and situational syncope in 1 patient (14. Larger studies are needed to confirm these findings. The term non-cardiac syncope includes all forms of syncope, in which primary intrinsic cardiac mechanism and non-syncopal transient loss of consciousness can be ruled out. The patient was discharged with mild symptoms of orthostatic intolerance and responded well to education and lifestyle modification. May 7, 2020 · Vasovagal syncope (VVS) is the most common type of syncope; the lone cardioinhibitory syncope represents only a small group of patients; however, the “cardioinhibitory component” is highly prevalent in reflex syncope and can be severe enough to produce asystole, lasting for a few seconds followed by a recovery to sinus beats. Despite promising outcomes, uncertainties persist regarding the efficacy and safety of CNA in patients with recurrent VVS. Apr 4, 2018 · All patients with reflex syncope and orthostatic hypotension should have the diagnosis explained, reassured, explained the risk of recurrence, and given advice on how to avoid triggers and situations. This reflex manifests as either a cardioinhibitory response without asystole and preceded by a drop in blood pressure prior to bradycardia or with asystole > 3 s with blood May 23, 2024 · Cardioneuroablation (CNA) is a catheter-based intervention for recurrent vasovagal syncope (VVS) that consists in the modulation of the parasympathetic cardiac autonomic nervous system. Reflex syncopes are a heterogeneous group of disorders mediated by cardiovascular reflexes that are inappropriately triggered, producing vasodilation or bradycardia, with a resultant fall in both blood pressure and cerebral perfusion. Jun 7, 2005 · The 2 most frequent types of reflex syncope are neurocardiogenic (vasovagal) syncope and carotid sinus syndrome. These issues constitute The reflex leads to vagal activation and/or withdrawal of sympathetic outflow, which causes a drop in cerebral perfusion and syncope. Carotid sinus syndrome (CSS) is a disease of the autonomic nervous system presenting with syncope, especially in older males who often have cardiovascular disease. Patients with recurrent syncope are first treated with conservative measures such as fluid and salt intake, trigger By far the most common cause of syncope in young subjects is a reflex syncopal event and in particular a vasovagal faint 1–4 This disorder is the focus of the present review. Bradycardia is not necessarily the cause of and can occur distinctly after a faint due to a vasovagal reflex (Figure 1A). Jul 31, 2021 · The aim of this article is to review the most recent literature, to describe the CLS algorithm, to report plausible evidence-based hypotheses of CLS activation during reflex syncope, and to provide practical advice on the use and programming of the CLS algorithm based on our experience. Aug 28, 2025 · The pathophysiology of reflex syncope involves autonomic dysfunction, where increased parasympathetic and reduced sympathetic activity lead to significant bradycardia or asystole in the cardioinhibitory subtype. The breakdown of balance in the autonomic regulation of heart rate or blood pressure, caused by predominant parasympathetic effect and decreased sympathetic tone, results in The first is a reflex bradycardia, known as cardioinhibitory reflex syncope. Vasovagal syncope (VVS), the most common cause of syncope, results from a neurocardiogenic reflex, representing an imbalance of the autonomic control, leading to bradycardia (cardioinhibitory response) and/or hypotension (vasodepressor response), preceding syncope. Reflex syncope and orthostatic hypotension are the most frequent aetiologies Jan 14, 2025 · Learn more about vasovagal syncope treatment using cardioneuroablation in this free article from AER Journal. Reflex syncope. Dec 30, 2024 · Aim In light of many recent advances in the field of vasovagal syncope, a selective review has been undertaken of these developments. This mini-review Feb 27, 2020 · PM affects cardioinhibitory syncope by preventing asystole through stimulation during vagal reflex. These measures are the cornerstone of treatment and have a high impact in reducing the recurrence of syncope. Abstract The most frequent cause of syncope is vasovagal reflex. Many circulatory disturbances (e. Jan 20, 2011 · Stimulation of the vagal efferent fibers ultimately occurs causing a vasodepressor and/or cardioinhibitory response, in addition to sympathetic withdrawal. This review discusses the following issues: the pathophysiological mechanisms behind reflex syncope, particularly cardioinhibitory and vasodepressor responses; the definition of loss of consciousness and differential diagnosis of syncope; differential diagnosis of atrioventricular (AV) block of extrinsic and intrinsic cause; and a brief review Nov 15, 2021 · Syncope is a symptom that is commonly encountered in the practice and may point to a cardiac or neurological diagnosis. The CI response due to a reflex mechanism is typically a diagnosis of exclusion, after the anatomical involvement of the sinus node (SN) and atrioventricular (AV) node was ruled out. Reflex syncopes can be classified as vasovagal, situational, carotid sinus, and atypical (192; 40). (Cardioneuroablation for Reflex Syncope [ROMAN]; NCT03903744). Nov 20, 2024 · Vasovagal syncope is by far the most common type of syncope across all age groups. Several studies have shown a typical sequence of events: blood pressure reduction, followed by a sympathetic surge 3 superseded by a parasympathetic outbreak, with asystole or bradycardia and, finally, loss of consciousness seconds after bradycardia. The heterogeneity of the forms and clinical manifestations of reflex syncope explain the controversial results of older randomised clinical trials. Reflex syncope is a brief loss of consciousness due to a neurologically induced drop in blood pressure or heart rate. Careful clinical and electrophysiologic testing may The TTS triggers were: vasovagal syncope in 6 patients (85. The vasovagal cardio-inhibitory reflex response has been characterized by detailed analysis of spontaneous events either recorded by an implantable cardiac monitor or triggered during head-up tilt testing (HUTT). A sudden reduction of brain-wave amplitude then ensued, leading to the disappearance of electrocerebral activity (“flat” EEG). The heterogeneity of the forms and clinical manifestations of reflex syncope explain the controversial results of older randomised clinical Abstract The most frequent cause of syncope is vasovagal reflex. Mar 17, 2021 · Swallow (deglutition) syncope is a rare form of neurally mediated cardioinhibitory reflex syncope occurring during swallowing. Theoretically, in VVS, CNA works to prevent vagal efferent arm of reflex arc in cardioinhibitory type or in mixed type with a predominant cardioinhibitory response Figure 2. Reex syncope can result from a purely vasodepres-sor effect or, less frequently, a solely cardioinhibitory response,9 depending on whether the efferent response inhibits sympathetic tone or increases parasympathetic tone, respectively. (ACC-AHA) Mar 26, 2024 · Abstract The term non-cardiac syncope includes all forms of syncope, in which primary intrinsic cardiac mechanism and non-syncopal transient loss of consciousness can be ruled out. g. A low peripheral resistance can be caused by an inappropriate reflex, or autonomic failure. The aim of our study was to evaluate the prevalence and clinical predictors of cardioinhibitory (CI) responses with asystole at the nitroglycerin (NTG)-potentiated head-up tilt test (HUTT) in patients with a history of syncope admitted to a tertiary Reflex syncope refers to a group of related disorders that trigger inappropriate cardiovascular reflexes producing hypotension and syncope. Jun 20, 2022 · Abstract Syncope presents a proportion of up to 25% among children and adolescents and accounts for 0. Oct 30, 2007 · Cardioinhibitory syncope (CS) is a neurally mediated response causing bradycardia or asystole. 3%). The main three forms of syncope include (1) reflex syncope, known also as neurocardiogenic syncope, (2) orthostatic hypotension and (3) cardiogenic syncope which usually occurs due to cardiac arrhythmia but sometimes also due to structural heart disease which reduces cardiac output. 7 Apr 24, 2025 · Introduction The most common form of reflex syncope, vasovagal syncope (VVS), is a clinical entity manifest by suddenly occurred bradycardia (cardioinhibition) and hypotension (vasodepression) [1]. Implantable loop recorder tracing revealing cardioinhibitory response during presyncope in a patient with neurally mediated syncope. Catheter Ablation for Vasovagal Syncope. Nevertheless, many issues concerning clinical indications, methodology, and long-term results remain unresolved. brady- or tachyarrhythmias, reflex cardioinhibition-vasodepression-hypotension) may trigger a syncope or near-syncope episode, and identifying the cause(s) is often challenging. May 1, 1997 · The best known of these syndromes are the vasovagal faint and the hypersensitive carotid sinus syndrome. Some syncope may Cardiac pacing has been studied extensively in patients with reflex syncope over the past two decades. Jul 25, 2024 · As a result, the cardioinhibitory reflex is inhibited, potentially reducing syncope episodes. The first is a reflex causing bradycardia, known as cardioinhibitory type of reflex syncope. Sep 1, 2019 · A cardioinhibitory response was defined as syncope reproducible on tilt testing associated with asystole ≥3 s or HR<60 bpm. Its most frequent aetiology is neurally mediated syncope, which includes vasovagal syncope and orthostatic hypotension. Forty new It is useful in patients with true reflex syncope, as it has been demonstrated that a positive cardioinhibitory response is highly predictive of asystolic spontaneous syncope [42]. 11,15,16 Transient hypotension results from the peripheral vasodilatation and bradycardia, yielding a reduction in cerebral blood flow and loss of consciousness, which usually lasts for May 20, 2022 · Clinically, the Bezold-Jarisch reflex is an inhibitory reflex usually denoted as a cardioinhibitory reflex defined as bradycardia, vasodilation, and hypotension resulting from stimulation of cardiac receptors. These issues constitute Nov 14, 2023 · The Bezold–Jarisch reflex, first described in 1867, is a cardioinhibitory reflex that is hypothesized to cause bradycardia, hypotension and syncope, but its anatomical and physiological bases Mar 20, 2012 · Independent Risk Factor: Advancing Age Syncope in seniors can be attributed to age-related neurohumoral and physiological changes in conjunction with medications (TABLE 1) and comorbid chronic diseases, ultimately decreasing the delivery of cerebral oxygen via multiple mechanisms. Sep 25, 2017 · During vasovagal syncope (VVS), bradycardia (“cardioinhibitory response”) and/or hypotension (“vasodepressor response”) may occur, decreasing cerebral blood flow and causing transient loss of consciousness (1). Initial step and pharmacological treatment may not work, especially in patients with recurrent syncope without prodrome. Neurally mediated syncopal syndrome includes carotid sinus syndrome, situational syncope, and neurocardiogenic syncope (also known as vasovagal syncope), which is the most common cause of syncope in both children and adults, accounting for 50-66% of unexplained syncope. Interestingly, 80% of fallers found to have carotid sinus syndrome are amnesic for witnessed associated loss of consciousness. The second is cardiovascular causes, due to arrhythmia and structural disease including pulmonary embolism/hypertension. The patient with a hypersensitive carotid sinus reflex and syncope may pose special challenges in evaluation and treatment. Nov 18, 2017 · It was previously accepted that this reflex caused syncope primarily through a vasodepressor response, but more recent investigation has shown that NCS may be the result of a cardioinhibitory mechanism as well, mediated primarily through bradycardia and an associated reduction in cardiac output. The mechanism of Vasovagal syncope (VVS), the most common type of syncope, should be assumed once other causes are excluded. Mar 7, 2025 · This case highlights an unusually pronounced cardioinhibitory response to photic stimulation successfully treated with pacemaker implantation. [1] Vasovagal syncope (VVS) is due to a common autonomic reflex involving the cardiovascular system. Patients may present to clinicians across multiple disciplines, so high awareness and careful evaluation are essential. Cardioinhibitory carotid sinus syndrome is more common, and easier to treat, than the vasodepressor type. The second concerns cardiovascular causes: arrhythmia, struc-tural disease including pulmonary embolism, and pulmonary hypertension. Clinically, these episodes may present as an isolated event with an identifiable trigger, or manifest as a cluster of recurrent episodes warranting intensive evaluation. Results and Conclusions The vasovagal syncope field is very Jun 15, 2021 · Approximately one-half of the population will have a syncopal event, mostly neurocardiogenic, a term which includes carotid sinus hypersensitivity, situational, and vasovagal syncope. Jul 18, 2021 · ). Methods Recent publications on the following topics were reviewed; understanding of vasovagal syncope pathophysiology, tilt-testing methodology and interpretation, drug, ablation and pacemaker therapy. Cardioneuroablation may obviate the need for a pacemaker in well-selected patients. Feb 6, 2023 · In our case, syncope was associated with a selective cardioinhibitory effect on the AV node, without concomitant sinus bradycardia. Jan 16, 2021 · Conclusion In patients receiving a pacemaker for bradyarrhythmic syncope, reflex syncope and orthostatic hypotension are the most frequent mechanisms of syncope/collapse recurrence after implantation. 1–3 Cardioinhibitory response with prolonged asystole and/or transient atrioventricular block induced by a massive vagal reflex is commonly observed in severely symptomatic cases. It could be a defense mechanism to preserve the brain and the heart from permanent damage related to severe ischemia. Syncope can be caused by a low peripheral resistance (vasodepressor type), a low cardiac output (cardioinhibitory type) or a combination of both. 1 VVS is generally categorized into 3 types: cardioinhibitory, vasodepressive, and mixed type. If cardiac syncope is unlikely, reflex (neurally mediated) syncope and orthostatic hypotension are the most frequent causes of transient loss of consciousness. The other types of reflex syncopes are often referred to as situational because they are often associated with specific activities or conditions. A tool recommended for diagnosing the etiology of syncope is an Implantable Loop Recorder (ILR). 21 Other fairly well-recognized reflex syncopes include cough-induced syncope, 23 postmicturition syncope, 19 postswallow syncope, 4 and postdefecation syncope. Jan 3, 2022 · A 35-year-old male patient presented to the emergency department with a 10-day history of postural syncope and fever. Jan 3, 2022 · Although temporary pacing was able to abort syncope, a decision was made to hold off on permanent pacing as the most likely aetiology was felt to be temporary cardioinhibitory reflex syncope associated with COVID-19. This study reports on changes in blood pressure, heart rate variability (HRV), and ECG patterns before and after syncope with asystole. It is associated with worse quality of life, depression, fatigue and physical injury. 2 patients underwent a comprehensive clinical evaluation which showed a cardioinhibitory response. The heterogeneity of the forms and clinical manifestations of reflex syncope explain the controversial results of older randomised clinical Nov 4, 2019 · Both guidelines recommend pacemaker implantation for patients with recurrent reflex syncope in 2 specific circumstances: 1) patients with the cardioinhibitory or mixed forms of carotid sinus syndrome; and 2) patients older than age 40 years and evidence of symptomatic pauses for at least 3 s, or asymptomatic pauses for at least 6 s (Table 5). The usefulness of tilt-table test to select candidates for cardiac pacing is controversial. This review highlights syncope pathophysiology, dividing it into a central theory and a peripheral theory, the diagnosis explaining the head-up tilt test protocols, and treatments like CAN, representing it with figures for a simplified understanding. Our study suggests that CLS is an effective tool for preventing syncope recurrences in patients with recurrent, severe, or refractory cardioinhibitory VVS. Therefore, the inclusion of patients with only reflex cardioinhibitory syncope but not a mixed response (or at least the absence of differences between groups) would have allowed a more accurate comparison. The evaluation of syncope rests on a tho Vasovagal syncope is a common cause of recurrent syncope. As no specific therapy is effective for all types of non-cardiac syncope, identifying the underlying haemodynamic Jan 3, 2022 · Case summary: A 35-year-old male patient presented to the emergency department with a 10-day history of postural syncope and fever. Jun 5, 2023 · Vasovagal syncope (VVS) is the most frequent cause of transient loss of consciousness, variating from single or infrequent episodes to debilitating form with repetitive syncopes that severely compromise quality of life. Innovations in Treatment Approaches Efforts are being made to develop innovative treatment approaches that target the underlying mechanisms of cardioinhibitory vasovagal Reflex syncope, also known as neurocardiogenic or vasovagal syncope (VVS), is the most frequent etiology of syncope in young people without apparent cardiac or neurological pathology. Although this may cast doubts sometimes about the true functional nature of the AV block, the consistent relationship with food ingestion in this patient supported a reflex mechanism. Pathophysiologically, the vasovagal reflex is the result of a paradoxical autonomic response, leading to hypotension and/or bradycardia. ‘Trigeminocardiac’ reflex mechanisms are described which may explain this phenomenon in association with sinus node dysfunction. 3, 38 In the absence of symptom reproduction, CSH has been reported in 35% of Apr 24, 2025 · The Bezold-Jarisch reflex, also known as the cardioinhibitory reflex, is a complex physiological response that occurs in the body under certain circumstances. This distinction may affect the choice of therapy, with pacemakers a potential option for patients with severe, recurrent symptomatic Sep 28, 2023 · As the most common cause of syncope, vasovagal syncope (VVS) is the result of cerebral hypoperfusion caused by sudden-onset bradycardia and mediated by parasympathetic overdrive. The second concerns cardiovascular causes: arrhythmia, structural disease including pulmonary embolism, and pulmonary hypertension. This is a brief review Feb 1, 2009 · Different electrocardiographic manifestation of the cardioinhibitory reflex during tilt-induced and spontaneous (implantable loop recorder documented) vasovagal syncope The first step of syncope diagnostic assessment is to identify patients with cardiac syncope, and once established, these patients must receive the adequate mechanism-specific treatment. A concordant depression of both SN and AV node function is suggestive of a . 'Trigeminocardiac' reflex mechanisms are described which may explain this phenomenon in association with sinus node dysfunction. Reflex syncope and orthostatic hypotension are the most frequent aetiologies of non-cardiac syncope. jvswfsabyvxrxo4b136rfjbenulnu7wzdk7pja