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


: Tilt testing (TT) and other evidence suggest that the vagal effect on the heart decreases with age.

Objective: The main aim of the study was to assess whether this age effect also affects the rate of asystole in spontaneous reflex syncope (RS).

Method: We performed an analysis of pooled individual data from 4 studies that recruited patients ≥ 40-year-old affected by certain or suspected RS who received an implantable loop recorder (ILR) and reported follow-up data on syncope recurrence. We assessed the presence of asystolic syncope >3 s or non-syncopal asystole > 6 s recorded by ILR and compared findings to TT results on the same patients.

Results: A total of 1046 patients received ILR due to unexplained syncope. Of these, 201 (19.2%) had a documentation of an asystolic event of 10 (IQR 6-15) s duration. They were subdivided in 3 age-tertiles: ≤ 60 years (n=64), 61-72 years (n=72) and ≥73 years (n=65). The rate of asystolic events was similar in the 3 subgroups (50.1%, 50.1% and 49.2% respectively, p=0.99). Conversely, the rate of asystolic syncope induced during TT (performed in 169/201) was greatly age-dependent (31.0%, 12.1% and 11.1% in increasing age-tertiles, respectively, p=0.009).

Conclusion: The rate of spontaneous asystolic form of RS documented by ILR is constant at any age > 40 years. Conversely, the rate of asystolic syncope induced by TT is higher in younger patients and decreases with ageing. The contrasting results between spontaneous and tilt-induced events cast doubt on the concept that asystole in RS is less common in older patients.


Kalyanam Shivkumar, MD, PhD, FACC
CME Editor
Kenneth A. Ellenbogen, MD, FACC

Mahmoud Houmsse

Important Dates
Date of Release: March 25, 2024
Term of Approval/Date of CME/MOC Expiration: March 24, 2025


Availability: On-Demand
Expires on Mar 24, 2025
Cost: FREE
Credit Offered:
1 CME Credit
1 ABIM-MOC Point
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