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A. Basics
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Pathophysiology of reflex syncope response: Role of the autonomic nervous system and baroreflex function
Session:
Comunicações Orais - Sessão 07 - Cardiopatias congénitas e Cardiologia pediátrica
Speaker:
Sergio Matoso Laranjo
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.7 Pediatric Cardiology
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sergio Matoso Laranjo; Guilherme Lourenço; Teresa Mateus; Helena Fonseca; Isabel Rocha; Conceição Trigo; Mário Oliveira; Fátima F Pinto
Abstract
<p>BACKGROUND AND AIM:Syncope is a common medical problem during the lifetime, with a recurrence rate of 35%. Excluding cardiac disease, most syncopes are of reflex origin, and despite their frequent occurrence, their mechanisms are not yet well defined. Furthermore, while studies in the adult population with vasovagal syncope are abounding, few studies (with conflicting results) have investigated the vasovagal syncope mechanisms in paediatric patients.<br /> METHOD:238 patients were enrolled (range 12-18 years-old, mean age 13.4±4.1years, 64.3% females), having experienced, on average, 3.7±2.9 syncope episodes before the HUT. The population was divided according to the HUT response: tilt-positive patients (fainters) and tilt-negative patients (non-fainters). Heart rate (HR), blood pressure (BP), and cardiac haemodynamics were continuously monitored using a Task Force Monitor. In addition, HR variability (HRV), BP variability, baroreflex sensitivity (BEI), cross-spectral wavelet coherence, and phase were evaluated.<br /> RESULTS:The test was positive in 99 (41.8%) patients, representing the fainters' group. 38 patients (38%) were defined as cardioinhibitory (type 2), 35 patients (35.4%) mixed type (Type 1) syncope and 26 (26.6%) as vasodepressor (Type 3). Fainters showed significantly higher HR, lower stroke volume and total peripheral resistance values during HUT. Four phases of cardiovascular responses leading to syncope could be described. Additionally, a significant rise in sympathetic activity characterised Fainters' HRV response to HUT. In brief, the core dynamic changes to LF included sudden and initial rise of sympathetic tone immediately after tilting up (Phase 1), followed by a significant decrease of sympathetic activity (Phase 2), the second overshoot of activity (Phase 3), and, then, a steady fall-off 1-2minutes before syncope (Phase 4). Despite similar BEI in the supine position, the fainters' group showed less systolic BP ramps and a higher lag of the baroreflex response. After HUT, the fainters' group showed a progressive but significant BEI decrease.<br /> CONCLUSIONS:These results strengthen the hypothesis that impaired baroreflex function and an imbalance between the two branches of the autonomic nervous system may represent a pathophysiological marker of altered response to orthostatic stress and play a role in the pathophysiology of reflex syncope. The findings can stratify reflex syncope patients to define an integrated and personalised therapeutic approach.</p>
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