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AIMS: Prior case series showed promising results for cardioneuroablation in patients with vagally induced atrioventricular blocks (VAVBs). We aimed to examine the acute procedural characteristics and intermediate-term outcomes of electroanatomical-guided cardioneuroablation (EACNA) in patients with VAVB. METHODS AND RESULTS: This international multicentre retrospective registry included data collected from 20 centres. Patients presenting with symptomatic paroxysmal or persistent VAVB were included in the study. All patients underwent EACNA. Procedural success was defined by the acute reversal of atrioventricular blocks (AVBs) and complete abolition of atropine response. The primary outcome was occurrence of syncope and daytime second- or advanced-degree AVB on serial prolonged electrocardiogram monitoring during follow-up. A total of 130 patients underwent EACNA. Acute procedural success was achieved in 96.2% of the cases. During a median follow-up of 300 days (150, 496), the primary outcome occurred in 17/125 (14%) cases with acute procedural success (recurrence of AVB in 9 and new syncope in 8 cases). Operator experience and use of extracardiac vagal stimulation were similar for patients with and without primary outcomes. A history of atrial fibrillation, hypertension, and coronary artery disease was associated with a higher primary outcome occurrence. Only four patients with primary outcome required pacemaker placement during follow-up. CONCLUSION: This is the largest multicentre study demonstrating the feasibility of EACNA with encouraging intermediate-term outcomes in selected patients with VAVB. Studies investigating the effect on burden of daytime symptoms caused by the AVB are required to confirm these findings.

Background: A Dieulafoy's lesion in the jejunum is at an uncommon site but may be the cause of massive gastrointestinal bleeding. It is characterized by a large, tortuous submucosal artery that erodes the overlying epithelium and presents diagnostic and therapeutic challenges due to its atypical location and presentation. Case: A 30-year-old male presented with sudden onset syncope and the passage of 200–300 ml of red blood-mixed stool. With no major comorbidities, he had hypotension with a blood pressure of 80/50 mmHg, necessitating immediate transfusion of three units of packed red blood cells (PRBCs). Initial endoscopic evaluations, including an UGI endoscopy and colonoscopy, failed to locate the bleeding source. CT angiography identified an active bleed from the first jejunal branch leading to coil embolization. Persistent symptoms prompted capsule endoscopy, revealing angioectasia in the proximal jejunum. Despite haemoclip application and a total of 11 units of blood transfused, his symptoms persisted. He then underwent laparoscopic resection of the jejunal segment containing the polyp, followed by extracorporeal jejuno-jejunal anastomosis. Histopathology confirmed a benign polyp with central ulceration, consistent with a Dieulafoy's lesion. Conclusions: Advanced diagnostic techniques like CT angiography and capsule endoscopy played a pivotal role in localizing the bleeding source. Surgical intervention proved curative when less invasive methods failed. The patient's postoperative course was uneventful, highlighting the efficacy of a multidisciplinary approach. A high index of suspicion and a multidisciplinary approach are essential for successful outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This retrospective study aimed to analyze the symptom profile of Meniere's disease (MD) patients, particularly focusing on the cessation of episodic vertigo and the disease's longitudinal course and the impact of major symptoms on quality of life (QoL). Methods: The study employed a cross-sectional design and was conducted on 365 out of 560 individuals with definite MD from the Finnish Vestibular and Meniere Federation, utilizing an internet-based questionnaire. Participants were surveyed on vertigo attacks, vestibular drop attacks (VDA), balance issues, selective cognitive complaints, hearing loss, and their effects on overall quality of life (QoL). The study population comprised 79.5% females and 20.5% males, with a mean age of 63 years and an average disease duration of 15.2 years. Results: The onset of MD was characterized by simultaneous hearing loss, vertigo, and tinnitus in 38% of participants. There was a significant delay in diagnosis for many, with 20% experiencing a delay of over 5 years. The frequency and duration of vertigo attacks generally decreased over time, with attacks becoming shorter and less severe as the disease progressed. Spontaneous remission from episodic vertigo occurred in 34% of participants variably throughout the course of MD. Of the participants 65.5% reported balance issues, and 34% experienced mild VDAs, with severe falls occurring in 10%. VDAs were more common with longer disease duration. Bilateral hearing loss developed in 34.5% of participants over the long term, with a higher risk associated with younger onset age, migraines, and family history of MD. Fatigue, anxiety, and depression were prevalent, particularly among younger participants. Cognitive impairments were linked to the severity of these symptoms and the presence of constant dizziness. QoL was significantly lower among participants with constant dizziness, with factors like fatigue, depression, VDA, and hearing loss contributing to this reduction. Conclusions: The study highlights the complexity of MD. While vertigo may spontaneously remit, other symptoms such as VDAs, balance issues, cognitive complaints, and hearing loss often persist and worsen over time. Assessing MD solely on primary symptoms like vertigo and hearing loss is insufficient; a comprehensive evaluation is necessary for effective management. [ABSTRACT FROM AUTHOR]

Background: Clinical practice suggests that older adults (i.e., ≥ 65 years of age) experience adverse drug reactions (ADRs) more often than younger patients (i.e., < 65 years of age). ADRs such as falls, extrapyramidal symptoms (EPS), metabolic disorders, sedation, and delirium are particularly worrisome and often associated with psychotropic drugs. Methods: This observational study investigated the risk for psychotropic drug-related ADRs in older (n = 99,099) and younger adults (n = 363,562) in psychiatric inpatients using data from the German pharmacovigilance program "Arzneimittelsicherheit in der Psychiatrie" (AMSP) from 1993–2016. The aim was to assess whether age influenced the risk of specific ADR types and if certain psychotropic drugs posed particular concerns. Results: The risk for ADRs did not differ between older and younger patients (relative risk 0.98, 95% confidence interval 0.92–1.05). However, older patients had a higher risk for delirium (2.35, 1.85–2.99), hyponatremia (3.74, 2.85–4.90), and orthostatic syncope (2.37, 1.72–3.26), as well as certain types of EPS, e.g., parkinsonism (1.89, 1.45–2.48) and Pisa-/metronome syndrome (3.61, 2.51–5.18). The risk for other ADRs, such as acute dystonia (0.20, 0.10–0.37), akathisia (0.47, 0.29–0.76), liver dysfunction (0.63, 0.48–0.82), weight gain (0.07, 0.04–0.14), sexual dysfunction (0.03, CI 0.00–0.25), and hyperprolactinemia/galactorrhea (0.05, 0.02–0.17) was significantly lower for older patients. Older patients treated with any type of antidepressant drug (1.33, 1.26–1.40)—especially selective serotonin reuptake inhibitors (1.57, 1.26–1.40) and selective serotonin-norepinephrine reuptake inhibitors (2.03, 1.80–2.29)—and lithium (1.74, 1.52–2.00) had a higher ADR risk than younger patients. Second-generation antipsychotic drugs had a lower (0.74, 0.71–0.77) and low-potency first-generation antipsychotic drugs a higher (1.19, 1.07–1.33) ADR risk in older patients. The risk for ADRs involving multiple drugs was higher in older patients (1.28, 1.22–1.34). ADRs in older patients were 6.4 times more likely to result in death. Conclusions: Clinicians and pharmacists should be aware of the types of ADRs and high-risk drugs across age groups and provide appropriate monitoring. Pharmacovigilance is crucial in psychiatric patients of all ages and should not be neglected, even for drugs generally considered "safe". [ABSTRACT FROM AUTHOR]

Tpeak-Tend interval (Tp-Te) is an indicator of transmural dispersion of repolarization, which is often related to ventricular arrhythmias. The relationship between Tp-Te and vasovagal syncope (VVS) has been reported in previous studies, but very little is known about Tp-Te in differentiation between psychogenic pseudosyncope (PPS) and VVS in children. We aim to discuss the predictive value of Tp-Te of supine and orthostatic electrocardiogram (ECG) in the diagnosis between PPS and VVS in children. The 31 children with PPS and 40 children with VVS from July 2014 to November 2023 were enrolled as the study group. Meanwhile, 30 healthy children who underwent a physical examination in the same hospital were selected as the control group. Tp-Te and QT interval in 12-lead supine and orthostatic ECG were measured. (1) Supine ECG: ① The Tp-Te/QT in PPS group was significantly lower than that in control group in II lead (P < 0.05). The Tp-Te/QTc in PPS group was significantly lower than that in control group in II and aVR lead (P < 0.05). There was no significant difference in Tp-Te between PPS group and control group (P > 0.05). ② The Tp-Te in VVS group was significantly higher than that in control group in aVR, aVF, and V4 lead (P < 0.05). The Tp-Te/QT in VVS group was significantly higher than that in control group in aVF lead (P < 0.05). The Tp-Te/QTc in VVS group was significantly higher than that in control group in aVL, aVF and V1 lead (P < 0.05). ③ The Tp-Te, Tp-Te/QT in PPS group were significantly lower than those in VVS group in some leads (P < 0.05). The Tp-Te/QTc in PPS group was significantly lower than that in VVS group in some leads. (2) Orthostatic ECG: ① The Tp-Te in PPS group was significantly higher than that in control group in V1, V2 lead (P < 0.05). The Tp-Te/QT, Tp-Te/QTc in PPS group were significantly higher than those in control group in V2 lead (P < 0.05). ② The Tp-Te and Tp-Te/QTc in V4 lead, Tp-Te/QT in V1, V4 lead in VVS group were significantly higher than those in control group (P < 0.05). ③ The Tp-Te in PPS group was significantly lower than that in VVS group in some leads (P < 0.05). The Tp-Te/QT in PPS group was significantly lower than that in VVS group in some leads (P < 0.05). The Tp-Te/QTc in PPS group was significantly lower than that in VVS group in some leads. (3) The receiver-operating characteristic (ROC) curve analysis: Tp-Te of supine ECG and orthostatic ECG in some leads had a predictive value on diagnosis between PPS and VVS (P < 0.05). Tp-Te, Tp-Te/QT, and Tp-Te/QTc of supine and orthostatic ECG in some leads have a certain predictive value in the diagnosis between PPS and VVS in children. [ABSTRACT FROM AUTHOR]

Objective: Rare coexistence of disease or pathology Background: Diffuse large B-cell lymphoma is the most prevalent form of non-Hodgkin lymphoma, representing around a quarter of newly diagnosed cases of B-cell non-Hodgkin lymphoma. Diffuse large B-cell lymphoma is a disease that affects mostly older persons, with a median presentation in the 7th decade of life. Clinically, it has a variety of presentations, ranging from constitutional symptoms to local or systemic pressure effects caused by a rapidly growing mass. Only rarely do head and neck lymphomas present as syncopal events. Although diffuse large B-cell lymphoma frequently involves the cervical region, syncope from the condition without cardiac involvement has only been documented in a few cases to date. Case Report: A 66-year-old man experienced a sudden onset of recurrent syncopal episodes triggered by neck movement that had been ongoing for 2 weeks before his presentation. A rapidly enlarging left neck mass was first noticed 6 weeks earlier and he was treated with antibiotics. During a workup of the syncope, a diffuse large B-cell lymphoma was discovered to be encasing his left internal carotid artery without obstructing blood flow. Chemotherapy was initiated and resulted in complete neck mass and related syncope resolution. Follow-up positron emission tomography scan after 3 months of chemotherapy revealed an excellent response. Conclusions: Sudden onset of syncopal episodes may be the first or only indication of a neck or head malignancy. As a result, we should be aware of the possibility of an underlying malignancy in individuals with unexplained syncope. [ABSTRACT FROM AUTHOR]