Hemodynamic Sensors: Clinical Value in Vasovagal Syncope

  • D. G. Benditt
Conference paper


Devising hemodynamic sensors capable of recognizing an imminent vasovagal faint in the absence of abrupt bradycardia remains a challenge. The ultimate goal is to enable implantable treatment devices, whether pacemakers, drug infusion systems, neural stimulators, or combined systems, to react promptly and reliably interrupt an impending event, whether the hypotension be the result of cardioinhibition, vasodilation, or a combination of both. A more limited goal is to enhance operation of diagnostic instrumentation (e.g., implanted or external loop recorders) in order to facilitate the initial evaluation of syncope patients.


Muscle Sympathetic Nerve Activity Cardiac Pace Vasovagal Syncope Blood Flow Oscillation Syncope Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Van Lieshout JJ, Wieling W, Karemaker JM, Eckberg DL (1991) The vasovagal response. Clin Sci 81:575–586PubMedGoogle Scholar
  2. 2.
    Benditt DG, Goldstein MA, Adler S et al (1995) Neurally mediated syncopal syndromes: pathophysiology and clinical evaluation. In: Mandel WJ (ed) Cardiac arrhythmias, 3rd edn. Lippincott, Philadelphia, pp 879–906Google Scholar
  3. 3.
    Quan KJ, Carlson MD, Thames MD (1997) Mechanisms of heart rate and arterial blood pressure control: implications for the pathophysiology of neurocardiogenic syncope. Pacing Clin Electrophysiol 20 (pt II):764–774PubMedCrossRefGoogle Scholar
  4. 4.
    Lurie KG, Benditt DG (1996) Syncope and the autonomic nervous system. J Cardiovasc Electrophysiol 7:760–776PubMedCrossRefGoogle Scholar
  5. 5.
    Lippman N, Stein KM, Lerman BB (1995) Failure to decrease parasympathetic tone during upright tilt predicts a positive tilt-table test. Am J Cardiol 75:591–595PubMedCrossRefGoogle Scholar
  6. 6.
    Benditt DG, Chen M-Y, Hansen R et al (1995) Characterization of subcutaneous microvascular blood flow during tilt-table-induced neurally-mediated syncope. J Am Coll Cardiol 25:70–75PubMedCrossRefGoogle Scholar
  7. 7.
    Benditt DG, Lurie KG (1997) Sensors for early recognition of imminent vasovagal syncope. In: Raviele A (ed) Cardiac arrhythmias. Springer-Verlag Italia, Milan, pp 428–434Google Scholar
  8. 8.
    Benditt DG, Sutton R, Gammage M, Markowitz T, Gorski JA, Nygaard GA, Fetter J, and International Rate Drop Investigators Group (1997) Clinical experience with Thera DR rate-drop response pacing algorithm in carotid sinus syndrome and vasovagal syncope. Pacing Clin Electrophysiol 20 (Suppl II):832–839PubMedCrossRefGoogle Scholar
  9. 9.
    Sra J, Jazayeri MR, Avitall B et al (1993) Comparison of cardiac pacing with drug therapy in the treatment of neurocardiogenic (vasovagal) syncope with bradycardia or asystole. N Engl J Med 328:1085–1090PubMedCrossRefGoogle Scholar
  10. 10.
    Connolly SJ, Sheldon R, Roberts RS, Gent M (1999) The North American Vasovagal Pacemaker Study (VPS). A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. J Am Coll Cardiol 33:16–20PubMedCrossRefGoogle Scholar
  11. 11.
    Sutton R, Brignole M, Menozzi C, Raviele A, Alboni P, Giani P, Moya A for the VASIS Investigators (2000) Dual-chamber pacing is efficacious in treatment of neurally-mediated tilt-positive cardioinhibitory syncope. Pacemaker versus no therapy: a multicentre randomized study. Circulation 102:294–299PubMedCrossRefGoogle Scholar
  12. 12.
    Kurban AS, Erickson M, Petersen MEV et al (2000) Respiratory changes in vasovagal syncope. J Cardiovasc Electrophysiol 11:607–611CrossRefGoogle Scholar
  13. 13.
    Benditt DG, Samniah N (2000) Respiratory changes during the evolving vasovagal faint: physiologic and clinical implications. J Cardiovasc Electrophysiol 11:612–615PubMedCrossRefGoogle Scholar
  14. 14.
    Wallin BG, Sundlof, G (1982) Sympathetic outflow in muscles during vasovagal syncope. J Autonom Nerv Syst 6:287–291CrossRefGoogle Scholar
  15. 15.
    Ellenbogen KA, Morillo CA, Wood MA et al (1997) Neural monitoring of vasovagal syncope. Pacing Clin Electrophysiol 20 (Suppl II):788–794PubMedCrossRefGoogle Scholar
  16. 16.
    Petersen MEV, Williams TR, Erickson M, Sutton R (1997) Right ventricular pressure, dP/dt and PEI, during tilt-induced vasovagal syncope. Pacing Clin Electrophysiol 20 (Suppl II):806–809PubMedCrossRefGoogle Scholar
  17. 17.
    Brignole M, Menozzi C, Corbucci G et al (1997) Detecting incipient vasovagal syncope: atrioventricular acceleration. Pacing Clin Electrophysiol (Suppl II):801–805CrossRefGoogle Scholar
  18. 18.
    Deharo JC, Peyre JP, Ritter PHet al (1998) A sensor-based evaluation of heart contractility in patients with head-up tilt-induced syncope. Pacing Clin Electrophysiol 21:223–226PubMedCrossRefGoogle Scholar
  19. 19.
    Deharo JC, Peyre J-P, Chalvidan T et al (2000) Continuous monitoring of an endocardial index of myocardial contractility during head-up tilt test. Am Heart J 139:1022–1030PubMedCrossRefGoogle Scholar
  20. 20.
    Grubb BP, Wolfe DA, Samoil D et al (1993) Adaptive rate pacing controlled by right ventricular pre-ejection interval for severe refractory orthostatic hypotension. Pacing Clin Electrophysiol 16:801–805PubMedCrossRefGoogle Scholar
  21. 21.
    Osswald E (1997) Correlation of intracardiac impedance and right ventricular contractility during dobutamine stress test. In: Raviele A (ed) Cardiac arrhythmias. Centro Scientifico Editore, Venice, p 89Google Scholar
  22. 22.
    Occhetta E, Bortnik M, Pedrigi C et al (2000) Pacing rate automatic reaction to neuro-mediated hemodynamic changes. In: Santini M (ed) Progress in clinical pacing. CEPI, Rome, pp 542–547Google Scholar

Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • D. G. Benditt
    • 1
  1. 1.Cardiac Arrhythmia CenterUniversity of Minnesota Medical SchoolMinneapolisUSA

Personalised recommendations