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Europace Advance Access originally published online on March 13, 2007
Europace 2007 9(4):225-227; doi:10.1093/europace/eum027
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

SYNCOPE

The pattern of activation of the sympathetic nervous system during tilt-induced syncope

Dorota Zysko1,*, Jacek Gajek2, Ryszard Sciborski3, Jacek Smereka1, Igor Checinski1 and Walentyna Mazurek2

1 Teaching Department for Emergency Medical Service, Medical University of Wroclaw, Bartla Street 5, 51-618 Wroclaw, Poland; 2 Department of Cardiology, Medical University of Wroclaw, Poland; 3 Internal Ward Hospital Olawa, Olawa, Poland

A 49-year-old patient with a history of situational syncope and minimal electrocardiographic signs of accessory pathway is described. The evidence for pre-excitation was present only during the sympathetic activation caused by exercise testing and isoprenaline infusion. This phenomenon served as an indicator of significant adrenergic drive to the heart after the tilt-induced syncope.

The meaning of the observed electrocardiographic changes in the course of neurocardiogenic reaction and its contribution to the understanding of the sympatho-vagal balance during vasovagal syncope is discussed. The lack of preexcitation signs during syncope and its appearance several seconds after the syncope-related sinus pause indicates sympathetic withdrawal before and shortly after the asystole. The possible pathophysiological mechanisms are discussed.

Key Words: Autonomic nervous system, Tilt testing, Vasovagal syncope

* Corresponding author. Tel: +0048717840961; fax: +0048717840961. E-mail address: dzysko{at}wp.pl

Manuscript submitted 3 May 2006. Accepted after revision 14 January 2007.


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