Vasovagal syncope: state or trait?

PURPOSE OF REVIEW: The absence of a satisfactory comprehensive theory for vasovagal syncope has prompted attention towards a possible genetic origin. There are several features of this trait that suggest a genetic origin. The purposes of this review are to present a rationale for considering a genetic origin and critically summarize recent findings. RECENT FINDINGS: Key characteristics that suggest a genetic origin are incomplete effect in the population, a persistent clinical phenotype, and the absence of obvious infectious or autoimmune causes. There are familial pedigrees of vasovagal syncope, and statistical analyses of the impact of family history on the likelihood of an individual fainting that suggest an autosomal dominant transmission with incomplete penetrance. There is also evidence of sex-specific penetrance. Early candidate gene studies point towards involvement of sympathetic signal transduction in the physiologic cascade. SUMMARY: Several epidemiologic characteristics of vasovagal syncope suggest that it may have a genetic origin.

[Emergency percutaneous valvuloplasty: Which patients, which results?] / La valvuloplastie percutanée en urgence : quels patients, quels résultats ?

Balloon aortic valvuloplasty is a relatively simple procedure with a low rate of complications despite patients' frailty. Urgent balloon aortic valvuloplasty is especially useful in patients with temporary contra-indication to TAVI or in case of difficult clinical scenario. It allows for a functional improvement for up to 6 months. This period should be used to bridge the patient to TAVI or surgical aortic valve replacement, stand-alone aortic valvuloplasty being without mid-term survival benefit.

A Prospective Analysis of Early Discharge After Transfemoral Transcatheter Aortic Valve Implantation.

As transcatheter aortic valve implantation (TAVI) becomes more routinely used, the recommended duration of monitoring after uncomplicated TAVI remains indeterminate. Retrospective analysis suggests that discharge within 72 hours is safe, but prospective data are largely lacking. We therefore prospectively assess the feasibility and safety of early discharge (within 72 hours) after transfemoral TAVI using Edwards SAPIEN-XT and SAPIEN-3 prostheses. Patients undergoing elective transfemoral TAVI were assessed prospectively for early discharge home. Feasibility and safety (death or repeat hospitalization within 30 days of discharge) of early discharge were assessed. Causes for failure of early discharge were assessed by prospective data collection and multivariate analysis. Of 130 patients, 76 (59%) were discharged early. Death or repeat hospitalization within 30 days occurred only in 4 cases (5%) among patients who discharged early: repeat hospitalization within 30 days was required in 3 early-discharge patients (4%), and there was a single death at 30 days. By multivariate analysis, factors associated with delayed discharge were blood transfusion (hazard ratio 13.85, 95% CI 1.61 to 119.40, p = 0.017) and pacemaker implantation (hazard ratio 4.47, 95% CI 1.34 to 14.26, p = 0.012). In conclusion, early discharge after elective transfemoral TAVI with SAPIEN-XT/SAPIEN-3 prostheses is safe and attainable in a large proportion of patients, with no evident compromise in safety. Factors associated with failure of early discharge are postprocedural blood transfusion and permanent pacemaker implantation.