The Rate of Asystolic Reflex Syncope is Not Influenced by Age (JCEP March 2024)-Article: The Rate of Asystolic Reflex Syncope is Not Influenced by Age

Article: The Rate of Asystolic Reflex Syncope is Not Influenced by Age

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A study conducted by Brignole et al. aimed to assess the influence of age on the rate of asystolic reﬂex syncope (RS) using data from patients aged 40 years and older. They found that the rate of spontaneous asystolic RS documented by an implantable loop recorder (ILR) remained constant across different age groups, indicating that age did not affect the occurrence of asystolic pauses in RS patients above 40 years old. However, the rate of asystolic syncope induced by a head-up tilt test (HUT) was higher in younger patients and decreased with age. This contrast in results between spontaneous and HUT-induced events raised questions about the belief that asystole in RS is less common in older patients.<br /><br />The study suggested that various factors, including age-related changes in neural control, intrinsic properties of the heart, and responses to stressors, contribute to the different outcomes observed in younger and older RS patients during diagnostic tests like HUT. The findings also emphasized the importance of accurately diagnosing the mechanism of syncope to tailor appropriate treatments such as cardiac pacing or cardioneuroablation for patients with severe RS.<br /><br />The study had certain limitations, such as the exclusion of patients with intrinsic cardiac pauses and the focus on a specific population seeking specialist evaluation. The clinical implications highlighted the need for a comprehensive assessment of both hypotensive and bradycardic phenotypes in RS patients, considering age-related variations in diagnostic test responses and syncope mechanisms.<br /><br />Overall, the study added insights into the understanding of different age-related mechanisms underlying asystolic RS and the implications for personalized treatment strategies based on syncope mechanisms rather than just clinical presentation or etiology.

Keywords

asystolic reﬂex syncope

age influence

implantable loop recorder

head-up tilt test

neural control

cardiac pacing

cardioneuroablation

diagnostic tests

syncope mechanisms

personalized treatment strategies