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Characteristics of deceleration capacity and deceleration runs in vasovagal syncope

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Abstract

Purpose

Increased vagal activity plays a prominent role in vasovagal syncope (VVS). The aim of this study was to characterize vagal function in VVS by evaluating the heart rate (HR) deceleration capacity (DC) and the HR deceleration runs (DRs) in patients with VVS between attacks.

Methods

A total of 188 consecutive VVS patients were enrolled in the study, of whom 129 had positive head-up tilt test (HUTT); 132 healthy participants were enrolled as controls. DC, DRs (DR2, i.e., episodes of 2 consecutive beat-to-beat HR decelerations), and the sum of DR8-10 (very long DR [VLDR]) were calculated using 24-h electrograms. Clinical characteristics, DC, and DRs were compared among syncope groups and controls.

Results

Patients with VVS had higher DC (10.63 ± 2.1 vs. 6.58 ± 1.7 ms; P < 0.001) and lower minimum HR and DR6-10 than controls. No significant differences in DC or DR6-10 were found between the patients with positive and those with negative HUTT results. In multivariate logistic regression analysis, minimum HR ≥ 40 bpm (odds ratio [OR] 0.408, 95% confidence interval [CI] 0.167–0.989; P = 0.048), daytime DC ≥ 7.37 ms (OR 3.040, 95% CI 1.220–7.576; P = 0.013), and VLDR ≥ 0.046% (OR 0.306, 95% CI 0.138–0.679; P = 0.004) were demonstrated to be risk factors significantly associated with VVS.

Conclusion

Compared to healthy controls, patients with VVS demonstrated distinct HR deceleration profiles between attacks, including overall higher DC and lower DR6-10.

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Funding

This work was supported by the Beijing Municipal Science & Technology Commission (Z191100006619019), National High Level Hospital Clinical Research Funding (Zero Balance 2022-GSP-QZ-4), and the Central Public Welfare Fundamental Commission (2019XK320059).

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Author notes

  1. Jiakun Li, Wei Sun and Xu Yang contributed equally to this work.

Authors and Affiliations

  1. Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Jiakun Li, Bin Tu, Zihao Lai, Lihui Zheng & Yan Yao

  2. Cardiology department, Eastern Health–Box Hill Hospital, Melbourne, Australia

    Wei Sun

  3. Premium Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Xu Yang

  4. Cardiac Arrhythmia Center, Huazhong Fuwai Hospital, Heart Center, Henan Provincial People’s Hospital, The People’s Hospital of Zhengzhou University, Henan, China

    Simin Cai

  5. Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

    Feng Hu

  6. Cardiovascular Department, Fujian Institute of Hypertension, The First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China

    Zhiyuan Weng

  7. Department of Cardiovasology, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Yuhua District, Shijiazhuang, 050031, Hebei, China

    Shangyu Liu

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  1. Jiakun Li
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Corresponding authors

Correspondence to Lihui Zheng or Yan Yao.

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Li, J., Sun, W., Yang, X. et al. Characteristics of deceleration capacity and deceleration runs in vasovagal syncope. Clin Auton Res 34, 143–151 (2024). https://doi.org/10.1007/s10286-023-00989-z

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