Cardioneuroablation changes the type of vasovagal response in patients with asystolic reflex syncope

Abstract Background One of the primary goals of enucleation and evisceration surgery is the restoration of an adequate orbital volume through the use of appropriately sized alloplastic or autogenous tissues. In patients inadequately treated, post-enucleation or evisceration socket syndrome occurs. Fillers are an ideal alternative for eyelid and eyebrow arcade volume enhancement since their injection is easily performed in an outpatient setting avoiding several complications. The aim of this study is to report the use of hyaluronic acid (HA) fillers to treat volume deficits of the upper and lower eyelids, projecting the brow arcade and reducing the asymmetry. Methods Thirteen patients (2 male, 11 female, mean age 32.7 years) were treated from June 2012 to May 2020. Non-surgical treatment by HA filler injection for aesthetic rehabilitation of deep superior sulcus, inferior tear trough deformity, and scleral show was performed. Results No complications as orbital-ache and/or vasovagal response were reported during the injections. Minor complications such as light swelling at the site of injection, self-resolved within 2 days, were recorded. Stable results were observed at follow-ups. In two cases, two successive treatments were required at 3 and 6 years from the first injection. Conclusions Hyaluronic acid fillers offer a versatile and safe method for replacing soft tissue lost from the upper eyelid/brow complex in cases of post-enucleation or evisceration socket syndrome. Level of evidence: Level IV, therapeutic study.

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Reflex Syncope (Neurally Mediated Syncope)

Syncope ◽

10.1007/978-0-85729-201-8_11 ◽

2010 ◽

pp. 153-177 ◽

Cited By ~ 1

Author(s):

Michele Brignole ◽

David G. Benditt

Keyword(s):

Reflex Syncope ◽

Neurally Mediated Syncope

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PLEURAL REFLEX SYNCOPE

BMJ ◽

10.1136/bmj.2.3113.333-b ◽

1920 ◽

Vol 2 (3113) ◽

pp. 333-334

Author(s):

A. G. Levy

Keyword(s):

Reflex Syncope

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Patients with reflex syncope have a higher prevalence of atrial fibrillation than general population which is predicted by the type of the tilt table test response

European Heart Journal ◽

10.1093/eurheartj/ehab724.0325 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

J M Farinha ◽

L Parreira ◽

A F Esteves ◽

M Fonseca ◽

A Pinheiro ◽

...

Keyword(s):

Atrial Fibrillation ◽

Nervous System ◽

Autonomic Nervous System ◽

General Population ◽

Tilt Test ◽

Tilt Table Test ◽

Tilt Table ◽

Test Response ◽

Reflex Syncope ◽

Vasodepressor Response

Abstract Introduction Reflex syncope is the result of an imbalance between the sympathetic and parasympathetic nervous system. The autonomic nervous system has been associated to some forms of atrial fibrillation (AF). Objective The aim of this study was to assess the prevalence of AF in patients with reflex syncope and a positive tilt table test and to identify the type of tilt test response in patients with AF in comparison to patients without AF. Methods We retrospectively studied consecutive patients that underwent a tilt table test at our institution between 2016 and 2019. We selected those patients with a positive test. Patients with an implanted pacemaker at the time of the tilt test and patients followed in a different institution were excluded. Previous diagnoses of AF episodes were assessed. We analysed the clinical characteristics and the tilt table test results according to previous history of AF. Results We studied 49 patients with a positive tilt test. Seven (14.3%) patients had previously diagnosed paroxysmal AF at the time of the tilt table test. Patients with AF were older, had more frequently hypertension, and the tilt test response was more frequently a vasodepressor than mixed or cardioinhibitory response (71.4% vs. 28.6%) (Table). In univariate analysis, age and hypertension were associated with AF, respectively, OR 1.08 (95% CI 1.01–1.17), p=0.034 and OR 10.80 (95% CI 1.19–98.36), p=0.035. A vasodepressor response was also associated with AF (OR 6.25, 95% CI 1.06–36.74, p=0.043). Conclusions Patients with reflex syncope and a positive tilt table test had a higher prevalence of AF than the general population. A vasodepressor response was associated with AF as were age and hypertension, demonstrating the possible impact of the autonomic nervous system and the multifactorial nature of AF. FUNDunding Acknowledgement Type of funding sources: None.

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