Abstract
The autonomic nervous system has an important role in the pathophysiology of vasovagal syncope. The purpose of this investigation was to evaluate to what extent the autonomic system is involved in the mechanism of fainting and to characterize the profile of heart rate variability of individuals who are prone to undergo a critical event. Thirty patients (mean age 41 years) with vasovagal syncope and 15 comparable controls were monitored by 24-h electrocardiography. Heart rate variability was analysed over the whole 24 h and during the daytime and night-time using time domain parameters (average of heart periods, RR; standard deviation of heart periods, SDNN; standard deviation of the average of RR intervals over all the 5-min segments of the entire recording, SDANN; percentage of the total number of all RR intervals of pairs of adjacent RR intervals differing more than 50 ms over the entire recording, pNN50; the square root of the sum of the square of differences between adjacent RR intervals, rMSSD), as indicated by the Task Force for Clinical Use of Standard Measurements of Heart Rate Variability. These parameters explore the influence of the autonomic nervous system on sinus node function and provide information about the vagal control to the heart. Among these parameters, pNN50 and rMSSD were significantly reduced in individuals with vasovagal syncope when compared with controls, over each time period considered. The two parameters are related to high-frequency oscillations in the frequency domain and to the vagal influence of the heart. These results indicate that the vagal tone to the heart is altered in subjects who suffer from vasovagal syncope. The results of this study provide an insight into the pathophysiological mechanism of fainting and may offer another means of evaluating patients with syncope.
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References
Fitzpatrick A, Sutton R. Tilting towards a diagnosis in recurrent unexplained syncope.Lancet 1989;i: 658–660.
Almquist A, Goldenberg J, Milstein Set al. Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope.N Engl J Med 1989;320: 346–351.
Lagi A, Cipriani M, Fattorini L, Paggetti C, Macerata A. Observations on arterial baroreflex in neurally mediated vasodepressor syncope.Clin Autonom Res 1994;4: 307–309.
Sneddon JF, Counihan PJ, Bashir Y, Haywood GA, Ward DE, Camm AJ. Impaired immediate vasocontriction responses in patients with recurrent neurally mediated syncope.Am J Cardiol 1993;71: 72–76.
Sneddon JF, Counihan PJ, Bashir Y, Haywood GA, Ward DE, Camm AJ. Assessment of autonomic function in patients with neurally mediated syncope: augmented cardiopulmonary baroreceptor responses to graded orthostatic stress.J Am Coll Cardiol 1993;21: 1193–1198.
Thomson HL, Lele SS, Atherton J, Wright KN, Stafford W, Frenneaux MP. Abnormal forearm vascular responses during dynamic leg exercise in patients with vasovagal syncope.Circulation 1995;92: 2204–2209.
Baharav A, Mimouni M, Lehrman-Sagie T, Izraeli S, Akselrod S. Spectral analysis of heart rate in vasovagal syncope: the autonomic nervous system in vasovagal syncope.Clin Autonom Res 1993;3: 261–269.
Ten Harkel ADJ, Van Lieshout JJ, Karemaker JM, Wieling W. Differences in circulatory control in normal subjects who faint and who do not faint during orthostatic stress.Clin Autonom Res 1993;3: 117–124.
Cohen EA, Hara K, Simpson G, Senn BM, Floras JS. Assessment of sympathetic activation by lower body negative pressure using spectral analysis of heart rate variability and forearm plethysmography.Can J Cardiol 1991;7 (suppl. A): 119A.
Morillo CA, Klein GJ, Jones DL, Yee R. Time and frequency domain analyses of heart rate variability during orthostatic stress in patients with neurally mediated syncope.Am J Cardiol 1994;74: 1258–1262.
Lagi A, Cipriani M, Buccheri AM, Tamburini C Heart rate and blood pressure variability in orthostatic syncope.Clin Sci 1996;91: 62–64.
Lipsitz LA, Mietus J, Moody GB, Goldberger AL. Spectral characteristics of heart rate variability before and during postural tilt. Relations to aging and risk of syncope.Circulation 1990;81: 1803–1810.
Jose AD, Taylor RR. Autonomic blockade by propranolol and atropine to study intrinsic myocardial function in man.J Clin Invest 1969;48: 2019–2031.
Donald DE, Samueloff SL. Exercise tachycardia not due to blood-borne agents in canine cardiac denervation.Am J Physiol 1966;211: 703–711.
Yusuf S, Theodoropoulos S, Dhalla N, Mathias C, Yacoub M. Effect of beta blockade on dynamic exercise in human heart transplant recipients.Heart Transplant 1985;4: 312–314.
Malliani A, Pagani M, Lombardi F, Cerutti S. Cardiovascular neural regulation explored in the frequency domain.Circulation 1991;84: 482–492.
Task Force of European Society of Cardiology and the North America Society of Pacing and Electrophysiology. Heart rate variability. Standards of measurement, physiological interpretation and clinical use.Circulation 1996;93: 1043–1065.
Malliani A, Pagani M, Lombardi F. Methods for assessment of sympatho-vagal balance. In: Levy MN, Schwartz P, eds.Vagal Control of the Heart: Experimental Basis and Clinical Implication. Armonk, NY: Futura Publishing Co. Inc., 1994; 433–454.
Van Ravenswaaij CMA, Kollée LAA, Hopman JCW, Stoelinga GBA, Van Geijn HP. Heart rate variability.Ann Intern Med 1993;118: 436–447.
Malik M, Farrell T, Cripps J, Camm AJ. Heart rate variability in relation to prognosis after myocardial infarction: selection of an optimal processing technique.Eur Heart J 1989;10 (12): 1060–1074.
Kleiger RE, Bigger JT Jr, Bosner MSet al., Stability over time of variables measuring heart rate variability in normal subjects.Am J Cardiol 1991;68: 626–630.
Bigger JT Jr, Fleiss JL, Steinman RC, Rolnitzky LM, Kleiger RE, Rottman JN. Correlation among time and frequency domain measures of heart period variability two weeks after myocardial infarction.Am J Cardiol 1992;69: 891–898.
Bigger JT Jr, Albrecht P, Steinman RC, Rolnitzky LM, Fleiss JL, Cohen RJ. Comparison of time and frequency domain based measures of cardiac parasympathetic activity in holter recordings after myocardial infarction.Am J Cardiol 1989;63: 536–538.
Ewing DJ, Neilson JMM, Travis P. New method for assessing cardiac parasympathetic activity using 24-hour electrocardiograms.Br Heart J 1984;52: 396–402.
Bigger JT Jr, Kleiger RE, Fleiss JL, Rolnitzky LM, Steinman RC, Miller JP. Components of heart rate variability measured during healing of acute myocardial infarction.Am J Cardiol 1988;61: 208–215.
McAreavey D, Neilson JM, Ewing DJ, Russel DC. Cardiac parasympathetic activity during the early hours of acute myocardial infarction.Br Heart J 1989;62: 165–170.
Zuanetti G, Latini R, Neilson JM, Schwartz PJ, Ewing DJ. Heart rate variability in patients with ventricular arrhythmias: effect of antiarrhythmic drugs.Am J Cardiol 1991;17: 604–612.
Goldsmith R, Bigger JT Jr, Steinman RC, Fleiss JL. A comparison of 24-hour parasympathetic activity in endurance trained and untrained men.J Am Coll Cardiol 1992;20 (3): 552–558.
Heslegrave RJ, Ogilvie JC, Furedy JJ. Measuring baseline treatment differences in heart rate variability: variance versus successive difference mean square and beats per minute versus interbeat intervals.Psychophysiology 1979;16: 151–157.
Bigger JT Jr, Fleiss JL. Methods for assessment of vagal tone and reflexes: time domain measures. In: Levy MN, Schwartz P, eds.Vagal Control of the Heart: Experimental Basis and Clinical Implication. Armonk, NY: Futura Publishing Co. Inc., 1994; 419–432.
Smith SE, Smith SA. Heart rate variability in healthy subjects measured with a bedside computer-based technique.Clin Sci 1981;61: 379–383.
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Lagi, A., Tamburini, C., Cipriani, M. et al. Vagal control of heart rate variability in vasovagal syncope: Studies based on 24-h electrocardiogram recordings. Clinical Autonomic Research 7, 127–130 (1997). https://doi.org/10.1007/BF02308839
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DOI: https://doi.org/10.1007/BF02308839