{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T11:35:17Z","timestamp":1774611317143,"version":"3.50.1"},"reference-count":47,"publisher":"Elsevier BV","issue":"3","license":[{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T00:00:00Z","timestamp":1740787200000},"content-version":"vor","delay-in-days":365,"URL":"http:\/\/www.elsevier.com\/open-access\/userlicense\/1.0\/"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jacc.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["JACC: Clinical Electrophysiology"],"published-print":{"date-parts":[[2024,3]]},"DOI":"10.1016\/j.jacep.2023.11.021","type":"journal-article","created":{"date-parts":[[2024,1,21]],"date-time":"2024-01-21T04:20:23Z","timestamp":1705810823000},"page":"566-574","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Rate of Asystolic Reflex Syncope Is\u00a0Not Influenced by Age"],"prefix":"10.1016","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1845-5607","authenticated-orcid":false,"given":"Michele","family":"Brignole","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Groppelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9227-0360","authenticated-orcid":false,"given":"Vincenzo","family":"Russo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5352-6327","authenticated-orcid":false,"given":"Artur","family":"Fedorowski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gert","family":"van Dijk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Alboni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"key":"10.1016\/j.jacep.2023.11.021_bib1","doi-asserted-by":"crossref","first-page":"18011","DOI":"10.1073\/pnas.1308477110","article-title":"Depressed pacemaker activity of sinoatrial node myocytes contributes to the age-dependent decline in maximum heart rate","volume":"110","author":"Larson","year":"2013","journal-title":"Proc Natl Acad Sci U S A"},{"key":"10.1016\/j.jacep.2023.11.021_bib2","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1253\/jcj.57.760","article-title":"Age-related changes of sinus node function and autonomic regulation in subjects without sinus node disease\u2013assessment by pharmacologic autonomic blockade","volume":"57","author":"Kuga","year":"1993","journal-title":"Jpn Circ J"},{"key":"10.1016\/j.jacep.2023.11.021_bib3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11357-021-00420-3","article-title":"Slowing down as we age: aging of the cardiac pacemaker\u2019s neural control","volume":"44","author":"Choi","year":"2022","journal-title":"Geroscience"},{"key":"10.1016\/j.jacep.2023.11.021_bib4","first-page":"3173","article-title":"Age-related alterations in the cardiovascular response to adrenergic mediated stress","volume":"39","author":"Lakatta","year":"1980","journal-title":"Fed Proc"},{"key":"10.1016\/j.jacep.2023.11.021_bib5","first-page":"H620","article-title":"Respiratory sinus arrhythmias in humans: how breathing pattern modulates heart rate","volume":"241","author":"Hirsch","year":"1981","journal-title":"Am J Physiol"},{"key":"10.1016\/j.jacep.2023.11.021_bib6","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.biopsycho.2006.04.008","article-title":"Vagal modulation and aging","volume":"74","author":"De Meersman","year":"2007","journal-title":"Biol Psychol"},{"key":"10.1016\/j.jacep.2023.11.021_bib7","doi-asserted-by":"crossref","first-page":"H893","DOI":"10.1152\/ajpheart.00379.2020","article-title":"Rhythm dynamics of the aging heart: an experimental study using conscious, restrained mice","volume":"319","author":"Comelli","year":"2020","journal-title":"Am J Physiol Heart Circ Physiol"},{"key":"10.1016\/j.jacep.2023.11.021_bib8","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1038\/261333a0","article-title":"Plasma noradrenaline increases with age","volume":"261","author":"Ziegler","year":"1976","journal-title":"Nature"},{"key":"10.1016\/j.jacep.2023.11.021_bib9","doi-asserted-by":"crossref","first-page":"R909","DOI":"10.1152\/ajpregu.00335.2001","article-title":"The influence of aging on the human sympathetic nervous system and brain norepinephrine turnover","volume":"282","author":"Esler","year":"2002","journal-title":"Am J Physiol Regul Integr Comp Physiol"},{"key":"10.1016\/j.jacep.2023.11.021_bib10","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1002\/ar.1158","article-title":"Autonomic innervation of the human cardiac conduction system: changes from infancy to senility\u2013an immunohistochemical and histochemical analysis","volume":"264","author":"Chow","year":"2001","journal-title":"Anat Rec"},{"key":"10.1016\/j.jacep.2023.11.021_bib11","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1093\/oxfordjournals.eurheartj.a062120","article-title":"Variations of normal sinus node function in relation to age: role of autonomic influence","volume":"7","author":"De Marneffe","year":"1986","journal-title":"Eur Heart J"},{"key":"10.1016\/j.jacep.2023.11.021_bib12","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/BF01826230","article-title":"A\u00a0comparison of cardiovascular reflex tests and spectral analysis of heart rate variability in healthy subjects","volume":"3","author":"Sega","year":"1993","journal-title":"Clin Auton Res"},{"key":"10.1016\/j.jacep.2023.11.021_bib13","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1016\/S0735-1097(02)02967-4","article-title":"Age and hemodynamic response to tilt testing in those with syncope of unknown origin","volume":"41","author":"Kurbaan","year":"2003","journal-title":"J\u00a0Am Coll Cardiol"},{"key":"10.1016\/j.jacep.2023.11.021_bib14","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.biopha.2004.08.007","article-title":"Responses to tilt test in young and elderly with syncope of unknown origin","volume":"58","author":"Galetta","year":"2004","journal-title":"Biomed Pharmacother"},{"key":"10.1016\/j.jacep.2023.11.021_bib15","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0026489","article-title":"Physiological phenomenology of neurally-mediated syncope with management implications","volume":"6","author":"Schroeder","year":"2011","journal-title":"PLoS One"},{"key":"10.1016\/j.jacep.2023.11.021_bib16","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1093\/europace\/euab024","article-title":"Age-related tilt test response in patients with suspected reflex syncope","volume":"23","author":"Rivasi","year":"2021","journal-title":"Europace"},{"key":"10.1016\/j.jacep.2023.11.021_bib17","first-page":"997","article-title":"Influence of age on magnitude and timing of vasodepression and cardioinhibition in tilt-induced vasovagal syncope","volume":"8","author":"van Dijk","year":"2022","journal-title":"J\u00a0Am Coll Cardiol EP"},{"key":"10.1016\/j.jacep.2023.11.021_bib18","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1093\/eurheartj\/ehi842","article-title":"Early application of an implantable loop recorder allows a mechanism-based effective therapy in patients with recurrent suspected neurally mediated syncope","volume":"27","author":"Brignole","year":"2006","journal-title":"Eur Heart J"},{"key":"10.1016\/j.jacep.2023.11.021_bib19","doi-asserted-by":"crossref","first-page":"2566","DOI":"10.1161\/CIRCULATIONAHA.111.082313","article-title":"Pacemaker therapy in patients with neurally mediated syncope and documented asystole. Third International Study on Syncope of Unknown Etiology (ISSUE-3): a randomized trial","volume":"125","author":"Brignole","year":"2012","journal-title":"Circulation"},{"key":"10.1016\/j.jacep.2023.11.021_bib20","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1093\/europace\/euv343","article-title":"Standardized algorithm for cardiac pacing in older patients affected by severe unpredictable reflex syncope: 3-year insights from the Syncope Unit Project 2 (SUP 2) study","volume":"18","author":"Brignole","year":"2016","journal-title":"Europace"},{"key":"10.1016\/j.jacep.2023.11.021_bib21","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.hrthm.2016.08.046","article-title":"Mechanism of syncope without prodromes with normal heart and normal electrocardiogram","volume":"14","author":"Brignole","year":"2017","journal-title":"Heart Rhythm"},{"key":"10.1016\/j.jacep.2023.11.021_bib22","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1093\/europace\/eux321","article-title":"The benefit of pacemaker therapy in patients with neurally mediated syncope and documented asystole: a meta-analysis of implantable loop recorder studies","volume":"20","author":"Brignole","year":"2018","journal-title":"Europace"},{"key":"10.1016\/j.jacep.2023.11.021_bib23","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1093\/eurheartj\/ehy037","article-title":"2018 ESC guidelines for the diagnosis and management of syncope","volume":"39","author":"Brignole","year":"2018","journal-title":"Eur Heart J"},{"key":"10.1016\/j.jacep.2023.11.021_bib24","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1136\/heartjnl-2012-303220","article-title":"Vagally mediated atrioventricular block: pathophysiology and diagnosis","volume":"99","author":"Alboni","year":"2013","journal-title":"Heart"},{"key":"10.1016\/j.jacep.2023.11.021_bib25","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1016\/j.hrthm.2009.04.001","article-title":"Paroxysmal atrioventricular block","volume":"6","author":"Lee","year":"2009","journal-title":"Heart Rhythm"},{"key":"10.1016\/j.jacep.2023.11.021_bib26","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.1016\/j.hrthm.2009.06.025","article-title":"Paroxysmal atrioventricular block: are phase 3 and phase 4 block mechanisms or misnomers?","volume":"6","author":"El-Sherif","year":"2009","journal-title":"Heart Rhythm"},{"key":"10.1016\/j.jacep.2023.11.021_bib27","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1053\/eupc.2000.0125","article-title":"The Italian protocol: a simplified head-up tilt testing potentiated with oral nitroglycerin to assess patients with unexplained syncope","volume":"2","author":"Bartoletti","year":"2000","journal-title":"Europace"},{"issue":"8","key":"10.1016\/j.jacep.2023.11.021_bib28","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.tcm.2022.05.006","article-title":"Importance of resting heart rate","volume":"33","author":"Olshansky","year":"2022","journal-title":"Trends Cardiovasc Med"},{"key":"10.1016\/j.jacep.2023.11.021_bib29","doi-asserted-by":"crossref","first-page":"M95","DOI":"10.1093\/geronj\/45.3.M95","article-title":"Age-associated changes in the components of the atrioventricular conduction in apparently healthy volunteers","volume":"45","author":"Fleg","year":"1990","journal-title":"J\u00a0Gerontol"},{"key":"10.1016\/j.jacep.2023.11.021_bib30","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1093\/oxfordjournals.eurheartj.a061908","article-title":"Electrophysiology of normal anterograde atrio-ventricular conduction with and without autonomic blockade","volume":"6","author":"Alboni","year":"1985","journal-title":"Eur Heart J"},{"key":"10.1016\/j.jacep.2023.11.021_bib31","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1136\/hrt.44.2.168","article-title":"Autonomic effects on the human cardiac conduction system. Evaluation by intracardiac electrocardiography and programmed stimulation techniques","volume":"44","author":"Tonkin","year":"1980","journal-title":"Br Heart J"},{"key":"10.1016\/j.jacep.2023.11.021_bib32","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1093\/oxfordjournals.eurheartj.a062000","article-title":"Role of autonomic nervous system in the genesis of first and second degree atrio-ventricular nodal block","volume":"7","author":"Alboni","year":"1986","journal-title":"Eur Heart J"},{"key":"10.1016\/j.jacep.2023.11.021_bib33","doi-asserted-by":"crossref","first-page":"2116","DOI":"10.1093\/eurheartj\/ehac017","article-title":"Early and late-onset syncope: insight into mechanisms","volume":"43","author":"Torabi","year":"2022","journal-title":"Eur Heart J"},{"issue":"2","key":"10.1016\/j.jacep.2023.11.021_bib34","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1093\/europace\/eul179","article-title":"Is vasovagal syncope a disease?","volume":"9","author":"Alboni","year":"2007","journal-title":"Europace"},{"key":"10.1016\/j.jacep.2023.11.021_bib35","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1007\/s10286-017-0446-2","article-title":"Typical vasovagal syncope as a \u201cdefense mechanism\u201d for the heart by contrasting sympathetic overactivity","volume":"27","author":"Alboni","year":"2017","journal-title":"Clin Auton Res"},{"key":"10.1016\/j.jacep.2023.11.021_bib36","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1093\/europace\/eup097","article-title":"Indications for the use of diagnostic implantable and external ECG loop recorders","volume":"11","author":"Brignole","year":"2009","journal-title":"Europace"},{"issue":"3","key":"10.1016\/j.jacep.2023.11.021_bib37","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s10286-022-00864-3","article-title":"Cardioinhibitory syncope with asystole during nitroglycerin potentiated head up tilt test: prevalence and clinical predictors","volume":"32","author":"Russo","year":"2022","journal-title":"Clin Auton Res"},{"key":"10.1016\/j.jacep.2023.11.021_bib38","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1093\/europace\/euac154","article-title":"Prevalence of asystole during tilt test-induced vasovagal syncope may depend on test methodology","volume":"25","author":"Russo","year":"2023","journal-title":"Europace"},{"key":"10.1016\/j.jacep.2023.11.021_bib39","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1136\/heartjnl-2013-304399","article-title":"Diagnosis of neurally mediated syncope at initial evaluation and with tilt table testing compared with that revealed by prolonged ECG monitoring. An analysis from the Third International Study on Syncope of Uncertain Etiology (ISSUE-3)","volume":"99","author":"Ungar","year":"2013","journal-title":"Heart"},{"issue":"7","key":"10.1016\/j.jacep.2023.11.021_bib40","first-page":"1819","article-title":"Outcomes of primary vs. delayed strategy of implanting a cardiac monitor for unexplained syncope","volume":"11","author":"Yasa","year":"2022","journal-title":"J\u00a0Clin Med"},{"key":"10.1016\/j.jacep.2023.11.021_bib41","article-title":"Impact of cardiovascular neurohormones on onset of vasovagal syncope induced by head-up tilt","volume":"8","author":"Torabi","year":"2019","journal-title":"J\u00a0Am Heart Assoc"},{"issue":"8","key":"10.1016\/j.jacep.2023.11.021_bib42","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euad163","article-title":"Twenty-five years of research on syncope","volume":"25","author":"Fedorowski","year":"2023","journal-title":"Europace"},{"key":"10.1016\/j.jacep.2023.11.021_bib43","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1136\/heartjnl-2020-318261","article-title":"New insights in diagnostics and therapies in syncope: a novel approach to non-cardiac syncope","volume":"107","author":"Brignole","year":"2021","journal-title":"Heart"},{"key":"10.1016\/j.jacep.2023.11.021_bib44","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1080\/17434440.2023.2174428","article-title":"Tests for the identification of reflex syncope mechanism","volume":"20","author":"Brignole","year":"2023","journal-title":"Expert Rev Med Devices"},{"key":"10.1016\/j.jacep.2023.11.021_bib45","doi-asserted-by":"crossref","first-page":"P1804","DOI":"10.1016\/j.hrthm.2022.06.017","article-title":"Cardioneuroablation for vasovagal syncope: a systematic review and meta-analysis","volume":"19","author":"Vandenberk","year":"2022","journal-title":"Heart Rhythm"},{"key":"10.1016\/j.jacep.2023.11.021_bib46","first-page":"85","article-title":"Cardioneuroablation for reflex syncope: efficacy and effects on autonomic cardiac regulation\u2014a prospective randomized trial","volume":"9","author":"Piotrowski","year":"2023","journal-title":"J\u00a0Am Coll Cardiol EP"},{"issue":"5","key":"10.1016\/j.jacep.2023.11.021_bib47","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euad033","article-title":"Clinical controversy: methodology and indications of cardioneuroablation for reflex syncope","volume":"25","author":"Brignole","year":"2023","journal-title":"Europace"}],"container-title":["JACC: Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2405500X23009015?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2405500X23009015?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T07:33:37Z","timestamp":1762500817000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2405500X23009015"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3]]},"references-count":47,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["S2405500X23009015"],"URL":"https:\/\/doi.org\/10.1016\/j.jacep.2023.11.021","relation":{},"ISSN":["2405-500X"],"issn-type":[{"value":"2405-500X","type":"print"}],"subject":[],"published":{"date-parts":[[2024,3]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"The Rate of Asystolic Reflex Syncope Is\u00a0Not Influenced by Age","name":"articletitle","label":"Article Title"},{"value":"JACC: Clinical Electrophysiology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jacep.2023.11.021","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2024 by the American College of Cardiology Foundation. Published by Elsevier.","name":"copyright","label":"Copyright"}]}}