IRCCS Istituto Auxologico Italiano, Faint and Fall Research Centre, Ospedale San Luca, Milan, Italy.
IRCCS Istituto Auxologico Italiano, Faint and Fall Research Centre, Ospedale San Luca, Milan, Italy.
JACC Clin Electrophysiol. 2024 Mar;10(3):566-574. doi: 10.1016/j.jacep.2023.11.021. Epub 2024 Jan 17.
The head-up tilt test (HUT) and other evidence suggest that the vagal effect on the heart decreases with age.
The main aim of the study was to assess whether this age effect also affects the rate of asystole in spontaneous reflex syncope (RS).
We performed an analysis of pooled individual data from 4 studies that recruited patients ≥40 years of age 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 of >3 seconds or nonsyncopal asystole of >6 seconds recorded by ILR and compared the findings to tilt test results on the same patients.
A total of 1,046 patients received ILR because of unexplained syncope. Of these, 201 (19.2%) had a documentation of an asystolic event of 10-second (Q1-Q3: 6- to 15-second) duration. They were subdivided in 3 age tertiles: ≤60 years (n = 64), 61 to 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 HUT (performed in 169 of 201) was greatly age dependent (31.0%, 12.1%, and 11.1% in increasing age tertiles, respectively; P = 0.009).
The rate of the spontaneous asystolic form of RS documented by ILR is constant at any age >40 years. Conversely, the rate of asystolic syncope induced by HUT is higher in younger patients and decreases with age. The contrasting results between spontaneous and tilt-induced events cast doubt on the concept that asystole in RS is less common in older patients.
头高位倾斜试验（HUT）和其他证据表明，迷走神经对心脏的影响随着年龄的增长而降低。
本研究的主要目的是评估这种年龄效应是否也会影响自发性反射性晕厥（RS）中停搏的发生率。
我们对 4 项研究的汇总个体数据进行了分析，这些研究招募了年龄≥40 岁、患有明确或疑似 RS 的患者，这些患者接受了植入式环路记录器（ILR），并报告了晕厥复发的随访数据。我们评估了 ILR 记录的>3 秒的停搏性晕厥或>6 秒的非晕厥性停搏的存在，并将这些发现与同一患者的倾斜试验结果进行了比较。
共有 1046 名因不明原因晕厥而接受 ILR 治疗的患者。其中，201 名（19.2%）有 10 秒（Q1-Q3：6-15 秒）持续时间的停搏性事件记录。他们被分为 3 个年龄三分位组：≤60 岁（n=64）、61-72 岁（n=72）和≥73 岁（n=65）。在这 3 个亚组中，停搏性事件的发生率相似（分别为 50.1%、50.1%和 49.2%；P=0.99）。相反，HUT 期间诱发的停搏性晕厥的发生率与年龄密切相关（在 201 名患者中进行了 169 次 HUT，发生率分别为递增年龄三分位组的 31.0%、12.1%和 11.1%；P=0.009）。
ILR 记录的任何年龄>40 岁的 RS 自发性停搏形式的发生率是恒定的。相反，HUT 诱发的停搏性晕厥的发生率在年轻患者中较高，并随年龄增长而降低。自发性事件和倾斜诱导事件之间的对比结果对 RS 中停搏较少见于老年患者的概念提出了质疑。
