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Backgrounds: The purpose of the study was to assess the clinical outcome of patients with situational syncope (SS) compared to patients with vasovagal syncope (VVS)., Methods: We assessed the prevalence, patients' characteristics, and outcome of consecutive patients with SS and VVS who presented to the Faint and Fall Clinic (University of Wisconsin) between January 2013 and December 2015., Results: SS was found in 55/1,401 (4.0%) syncope patients with follow-up data available in 47 patients: defecation (n = 16), micturition (n = 15), cough (n = 10), swallow (n = 3), laughter (n = 1), sneeze (n = 1), and cough plus laughter (n = 1). Over the same time period, 252/1,401 patients (18%) were diagnosed with VVS with follow-up data available in 171 patients. Compared with VVS patients, SS patients were older, more likely to be male, had a higher prevalence of hypertension, had an absence of prodromes, and experienced more injuries at the time of syncope (P = 0.01 for all). During a mean follow-up duration of 15.4 ± 9.1 months, syncope recurred in 5/47 (10.6%) patients with SS and 16/171 (9.4%) patients with VVS. The recurrence rates at 1 year and 2 years were 20% (95% SE ± 13) and 40% (95% SE ± 20) for the SS group, and 23% (95% SE ± 13) and 43% (95% SE ± 20) for the VVS group (P = 0.6). No patient died., Conclusions: We have shown in a large cohort of consecutive patients with syncope that SS is a relatively infrequent form of reflex syncope with different clinical characteristics but similar recurrence rate to VVS., (© 2017 Wiley Periodicals, Inc.) more...

Background: According to the ACC/AHA/HRS guidelines, cardiac pacing is reasonable in patients with bifascicular block (BF-B) and syncope when other causes have been excluded. The purpose of this study was to assess the long-term outcome of patients with BF-B and unexplained syncope following cardiac pacing., Methods and Results: Between 2009 and 2015, we identified 43 consecutive patients (mean age of 78 ± 12 years, 64% males) who presented with syncope and BF-B and had received a pacemaker (PM). During a mean follow-up period of 31 ± 21 months, syncope recurred in seven patients (16%): 7% (95% standard error [SE] ± 3%) at 1 year and 18% (95% SE ± 7%) at 5 years. At univariable analysis, the only predictor of syncope recurrence was empiric pacing (P = 0.03). There were no syncope recurrences in the 12 patients who received a PM following a positive electrophysiological study (EPS) and the five patients with documentation of paroxysmal atrioventricular block (AVB) during cardiac monitoring (insertable loop recorder [ILR]), (EPS/ILR Group, n = 17) compared to seven of 26 (27%) patients who received empiric pacing (Empiric Group, n = 26; P = 0.02). Progression to high-degree AVB was documented during follow-up in 16 (37%) patients: nine of 17 (53%) patients in the EPS/ILR Group and seven of 26 (27%) patients in the Empiric Group (P = 0.11). There were no injuries reported during ILR monitoring., Conclusions: We have shown that syncope recurs not infrequently in patients with BF-B who received pacing for syncope. Nearly one in four patients who had empiric pacing suffered syncope recurrence compared to no recurrences in patients who received a PM following a positive EPS or documentation of transient AVB., (© 2016 Wiley Periodicals, Inc.) more...