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Evaluation of atrial fibrillation risk in patients with vasovagal syncope

Untersuchung des Risikos für Vorhofflimmern bei Patienten mit vasovagaler Synkope

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Abstract

Background

This study aimed to determine whether autonomic dysfunction in patients with vasovagal syncope with a positive tilt test may cause an alteration in atrial electromechanical properties and pose a risk for subsequent atrial arrhythmias, especially atrial fibrillation.

Methods

The data of 27 patients with vasovagal syncope and a matched control group comprising 28 healthy individuals were compared. All patients underwent a tilt table test. Atrial electromechanical intervals (PA) were measured from the mitral lateral annulus, mitral septal annulus, and tricuspid annulus with tissue Doppler imaging. Left atrium volumes were measured with the disc method in apical four-chamber imaging.

Results

Although atrial electromechanical intervals such as lateral PA, septal PA, and tricuspid PA durations were significantly longer (p = 0.009, p = 0.002, p = 0.011, respectively), interatrial, right intra-atrial, and left intra-atrial durations were similar in the vasovagal syncope group and the control group (p = 0.298, p = 0.388, p = 0.069, respectively). Left atrial volumes (maximum, minimum, and presystolic) were significantly increased in the vasovagal syncope group when compared with the control group (p = 0.001, p = 0.001, p = 0.007, respectively). There was no difference between vasovagal syncope types in terms of atrial electromechanical intervals.

Conclusion

Interatrial and intra-atrial intervals were similar in the vasovagal syncope group and the control group. However, an increase in atrial volumes and a prolongation of certain atrial electromechanical intervals were observed in patients with vasovagal syncope. These findings suggest an alteration in atrial electromechanics caused by autonomic dysfunction that can lead to subsequent atrial arrhythmias, especially atrial fibrillation.

Zusammenfassung

Hintergrund

Ziel der vorliegenden Studie war es zu untersuchen, ob eine autonome Dysfunktion bei Patienten mit vasovagaler Synkope und einem positiven Kipptischtest möglicherweise eine Veränderung der atrialen elektromechanischen Eigenschaften bewirkt und ein Risiko für in der Folge auftretende Vorhofarrhythmien darstellt, insbesondere für Vorhofflimmern.

Methoden

Dazu wurden die Daten von 27 Patienten mit vasovagaler Synkope und einer gematchten Kontrollgruppe mit 28 gesunden Personen verglichen. Alle Patienten wurden mittels Kipptischtest untersucht. Die atrialen elektromechanischen Intervalle (PA-Intervall) vom lateralen Mitralring, septalen Mitralring und trikuspidalen Mitralring wurden mit einer Gewebedoppleruntersuchung bestimmt. Die Volumina im linken Vorhof wurden mit der Scheibchen-Summationsmethode nach Simpson im apikalen 4‑Kammer-Blick ermittelt.

Ergebnisse

Obwohl die Dauer der atrialen elektromechanischen Intervalle wie laterales PA, septales PA und trikuspidales PA signifikant länger war (p = 0,009; p = 0,002 bzw. p = 0,011), war die Dauer interatrial, rechts intraatrial und links intraatrial in der Gruppe mit vasovagaler Synkope und in der Kontrollgruppe ähnlich (p = 0,298; p = 0,388 bzw. p = 0,069). Die linksatrialen Volumina (Maximum, Minimum und präsystolisch) waren in der Gruppe mit vasovagaler Synkope gegenüber der Kontrollgruppe signifikant erhöht (p = 0,001; p = 0,001 bzw. p = 0,007). Es bestand kein Unterschied zwischen den Typen vasovagaler Synkopen in Bezug auf die atrialen elektromechanischen Intervalle.

Schlussfolgerung

Die interatrialen und intraatrialen Intervalle waren in der Gruppe mit vasovagaler Synkope und in der Kontrollgruppe ähnlich. Jedoch wurde eine Zunahme der atrialen Volumina und eine Verlängerung bestimmter atrialer elektromechanischer Intervalle bei Patienten mit vasovagaler Synkope festgestellt. Diese Ergebnisse sprechen für eine Veränderung der atrialen elektromechanischen Prozesse, die durch eine autonome Dysfunktion verursacht wird, welche in der Folge zu Vorhofarrhythmien führen kann, insbesondere Vorhofflimmern.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Cardiology, Karadeniz Technical University, 61000, Trabzon, Turkey

    Mürsel Şahin MD & Merih Kutlu

  2. Suşehri State Hospital, Sivas, Turkey

    Adnan Duha Cömert

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  1. Mürsel Şahin MD
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  2. Adnan Duha Cömert
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  3. Merih Kutlu
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Correspondence to Mürsel Şahin MD.

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Conflict of interest

M. Şahin, A.D. Cömert and M. Kutlu declare that they have no competing interests.

This research was approved by the Karadeniz Technical University Medical Faculty Ethics Committee. All participants’ rights were protected and written informed consent was obtained before the procedures according to the Helsinki Declaration. All studies cited were in accordance with the ethical standards indicated in each case.

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Şahin, M., Cömert, A.D. & Kutlu, M. Evaluation of atrial fibrillation risk in patients with vasovagal syncope. Herz 47, 79–84 (2022). https://doi.org/10.1007/s00059-021-05038-x

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  • DOI: https://doi.org/10.1007/s00059-021-05038-x

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