{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T20:47:44Z","timestamp":1761511664805},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2000,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The evaluation of syncope occurring during exercise or occurring spontaneously in highly trained individuals presents a unique diagnostic challenge. It is of critical importance to exclude potential life-threatening disorders such as hypertrophic cardiomyopathy, long QT syndrome, right ventricular dysplasia, anomalous coronary artery distribution, valvular heart disease, myocarditis, or exercise-induced arrhythmia. This review is not directed towards identifying, treating, or determining athletic eligibility of individuals with such disorders. Rather, we endeavour to discuss the pathophysiology of exercise-induced neurocardiogenic syncope and to address the role of head upright tilt testing in evaluating syncope in athletic individuals in whom proper evaluation has excluded the presence of ischaemic heart disease or primary structural or electrical heart disease.<\/jats:p>","DOI":"10.1053\/eupc.1999.0065","type":"journal-article","created":{"date-parts":[[2002,7,26]],"date-time":"2002-07-26T11:25:59Z","timestamp":1027682759000},"page":"77-82","source":"Crossref","is-referenced-by-count":22,"title":["Exercise-induced neurocardiogenic syncope"],"prefix":"10.1093","volume":"2","author":[{"given":"D.","family":"Kosinski","sequence":"first","affiliation":[{"name":"Electrophysiology Section Division of Cardiology Department of Medicine, Medical College of Ohio Toledo, Ohio, U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.P.","family":"Grubb","sequence":"additional","affiliation":[{"name":"Electrophysiology Section Division of Cardiology Department of Medicine, Medical College of Ohio Toledo, Ohio, U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.J.","family":"Karas","sequence":"additional","affiliation":[{"name":"Electrophysiology Section Division of Cardiology Department of Medicine, Medical College of Ohio Toledo, Ohio, U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Frederick","sequence":"additional","affiliation":[{"name":"Electrophysiology Section Division of Cardiology Department of Medicine, Medical College of Ohio Toledo, Ohio, U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2000,1,1]]},"reference":[{"key":"2020090806034950600_b1","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1249\/00005768-199301000-00005","article-title":"Tilt table testing in the evaluation and management of athletes with recurrent exercise-induced syncope","volume":"25","author":"Grubb","year":"1993","journal-title":"Med Sci Sports Exerc"},{"key":"2020090806034950600_b2","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1136\/hrt.71.6.554","article-title":"Exercise-induced vasodepressor syncope","volume":"71","author":"Sneddon","year":"1994","journal-title":"Br Heart J"},{"key":"2020090806034950600_b3","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/S0002-8703(96)90446-9","article-title":"Exercise-induced neurocardiogenic syncope","volume":"132","author":"Kosinski","year":"1996","journal-title":"Am Heart J"},{"key":"2020090806034950600_b4","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/S0002-9149(99)80584-0","article-title":"Syncope associated with exercise, a manifestation of neurally-mediated syncope","volume":"75","author":"Sakaguchi","year":"1995","journal-title":"Am J Cardiol"},{"key":"2020090806034950600_b5","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1016\/0002-8703(95)90398-4","article-title":"Clinical presentation and long-term followup of athletes with exercise-induced vasodepressor syncope","volume":"129","author":"Calkins","year":"1995","journal-title":"Am Heart J"},{"key":"2020090806034950600_b6","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/0735-1097(94)90836-2","article-title":"26th Bethesda Conference: Recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities","volume":"24","author":"Maron","year":"1994","journal-title":"J Am Coll Cardiol"},{"key":"2020090806034950600_b7","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1146\/annurev.me.25.020174.002101","article-title":"Static (isometric) exercise and the heart: Physiological and clinical considerations","volume":"25","author":"Mitchell","year":"1974","journal-title":"Ann Rev Med"},{"key":"2020090806034950600_b8","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/S0733-8651(18)30238-8","article-title":"Physiologic consequences of systemic training","volume":"10","author":"Crawford","year":"1992","journal-title":"Cardiol Clin"},{"key":"2020090806034950600_b9","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1016\/0735-1097(94)90841-9","article-title":"Classification of sports. In: \u201826th Bethesda Conference: Recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities.\u2019","volume":"24","author":"Mitchell","year":"1994","journal-title":"J Am Coll Cardiol"},{"key":"2020090806034950600_b10","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1056\/NEJM197105062841809","article-title":"Maximal oxygen uptake","volume":"284","author":"Mitchell","year":"1971","journal-title":"N Eng J Med"},{"key":"2020090806034950600_b11","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1152\/jappl.1980.49.4.676","article-title":"Cardiovascular responses to static exercise in distance runners and weight lifters","volume":"49","author":"Longhurst","year":"1980","journal-title":"J Appl Physiol"},{"key":"2020090806034950600_b12","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1152\/jappl.1987.63.1.105","article-title":"Diminished baroreflex control of forearm vascular resistance in physically fit humans","volume":"63","author":"Mack","year":"1987","journal-title":"J Appl Physiol"},{"key":"2020090806034950600_b13","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1249\/00005768-199112000-00008","article-title":"Diminished baroreflex control of forearm vascular resistance following training","volume":"23","author":"Mack","year":"1991","journal-title":"Med Sci Sport Exerc"},{"key":"2020090806034950600_b14","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.1152\/jappl.1989.66.4.1886","article-title":"Influence of physical training on heart rate variability and baroreflex circulatory control","volume":"66","author":"Seals","year":"1989","journal-title":"J Appl Physiol"},{"key":"2020090806034950600_b15","first-page":"330","article-title":"Cardiovascular response to lower body negative pressure following endurance training","volume":"59","author":"Vroman","year":"1988","journal-title":"Aviat Space Environ Med"},{"key":"2020090806034950600_b16","first-page":"713","article-title":"Chronic endurance training: A condition of inadequate blood pressure regulation and reduced tolerance to LBNP","volume":"25","author":"Raven","year":"1993","journal-title":"Med Sci Sports Exer"},{"key":"2020090806034950600_b17","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1111\/j.1540-8159.1995.tb04666.x","article-title":"Pathophysiologic aspects of neurocardiogenic syncope: Current concepts and new perspectives","volume":"18","author":"Kosinski","year":"1995","journal-title":"Pac and Clin Electrophys"},{"key":"2020090806034950600_b18","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1016\/0735-1097(91)90798-E","article-title":"Echocardiographic demonstration of decreased left ventricular dimensions and vigorous myocardial contraction during syncope induced by head up tilt","volume":"18","author":"Shalev","year":"1991","journal-title":"J Am Coll Cardiol"},{"key":"2020090806034950600_b19","first-page":"578","article-title":"Cardiac adaptation to training: Is it the key to understand the high incidence of positive tilt test in athletes? (Abstr)","volume":"19","author":"Ferrario","year":"1996","journal-title":"Pacing and Electrophys"},{"key":"2020090806034950600_b20","article-title":"Hemodynamic responses of high fit runners during head up tilt testing to syncope. (Abstr)","volume":"11","author":"Ebert","year":"1993","journal-title":"Proceeding of American Autonomic Society, Nashville, Tenn"},{"key":"2020090806034950600_b21","first-page":"124","article-title":"Der einflubeiner 6 \u2013 Stundigen Immersion in thermo indifferentem wasser auf die regulation des kreislaufs and der leistuncsfahig keit bei trainlerten an untrainlerten. Pflugers arch ges","volume":"312","author":"Stegman","year":"1969","journal-title":"Physiology"},{"key":"2020090806034950600_b22","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1249\/00005768-199306000-00013","article-title":"Regulation of central blood volume and cardiac filling in endurance athletes. the Frank-Starling mechanism as a determinant of orthostatic tolerance","volume":"25","author":"Levine","year":"1993","journal-title":"Med Sci Sports Exer"},{"key":"2020090806034950600_b23","first-page":"702","article-title":"Cardiovascular responses during orthostasis: Effect of an increase in VO2max","volume":"55","author":"Convertino","year":"1984","journal-title":"Aviat Space Environ Med"},{"key":"2020090806034950600_b24","first-page":"551","article-title":"Aerobic fitness does not contribute to prediction of orthostatic intolerance","volume":"18","author":"Convertino","year":"1989","journal-title":"Med Sci Sports Exer"},{"key":"2020090806034950600_b25","first-page":"334","article-title":"Comparison of aerobic capacity, parasympathetic modulation, and orthostatic tolerance. Abstract","volume":"5","author":"Frederick","year":"1995","journal-title":"Clin Auton Res"},{"key":"2020090806034950600_b26","first-page":"293","article-title":"Influence of stature and physical fitness in tilt table and acceleration tolerance","volume":"40","author":"Klein","year":"1969","journal-title":"Aerospace Med"},{"key":"2020090806034950600_b27","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1249\/00005768-199306000-00012","article-title":"Effect of exercise training on cardiopulmonary baroreflex control of forearm vascular resistance in humans","volume":"25","author":"Mack","year":"1993","journal-title":"Med Sci Sports Exerc"},{"key":"2020090806034950600_b28","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1152\/jappl.1980.48.4.665","article-title":"Exercise training induced hypervolemia: Role of plasma albumin, renin and vasopressin","volume":"48","author":"Convertino","year":"1980","journal-title":"J Appl Physiol"},{"key":"2020090806034950600_b29","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1146\/annurev.ph.45.030183.001125","article-title":"Cardiovascular adaptations to physical training","volume":"45","author":"Blomquist","year":"1983","journal-title":"Annu Rev Physiol"},{"key":"2020090806034950600_b30","first-page":"99","article-title":"The effect of endurance training on cardiac vagal tone","volume":"5","author":"Munir","year":"1995","journal-title":"Clin Aut Res"},{"key":"2020090806034950600_b31","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/0735-1097(92)90007-A","article-title":"Comparison of 24 hour parasympathetic activity in endurance-trained and untrained young men","volume":"20","author":"Goldsmith","year":"1992","journal-title":"J Am Coll Cardiol"},{"key":"2020090806034950600_b32","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1016\/0002-8703(94)90046-9","article-title":"Effect of athletic training on heart rate variability","volume":"127","author":"Sacknoff","year":"1994","journal-title":"Am Heart J"},{"key":"2020090806034950600_b33","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1111\/j.0954-6820.1978.tb08462.x","article-title":"Cerebral attacks due to excessive vagal tone in heavily trained persons","volume":"204","author":"Rasmussen","year":"1978","journal-title":"Acta Med Scand"},{"key":"2020090806034950600_b34","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.7326\/0003-4819-120-12-199406150-00007","article-title":"Asystole after exercise in healthy persons","volume":"120","author":"Osswald","year":"1994","journal-title":"Ann Intern Med"},{"key":"2020090806034950600_b35","doi-asserted-by":"crossref","first-page":"1821","DOI":"10.1001\/archinte.1983.00350090203041","article-title":"Asystole following treadmill exercise in a man without organic heart disease","volume":"143","author":"Fley","year":"1983","journal-title":"Arch Int Med"},{"key":"2020090806034950600_b36","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/S0022-0736(87)80027-4","article-title":"Asystole with syncope following strenuous exercise in a man without organic heart disease","volume":"20","author":"Hirata","year":"1987","journal-title":"J Electrocardiol"},{"key":"2020090806034950600_b37","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1001\/jama.1973.03230090043016","article-title":"Life threatening vagal reaction to physical fitness test","volume":"226","author":"Schlesinger","year":"1973","journal-title":"JAMA"},{"key":"2020090806034950600_b38","doi-asserted-by":"crossref","first-page":"844","DOI":"10.7326\/0003-4819-106-6-844","article-title":"Post exertional cardiac asystole in a young man without organic heart disease","volume":"106","author":"Suycke","year":"1987","journal-title":"Ann Intern Med"},{"key":"2020090806034950600_b39","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1136\/bmj.1.3723.873","article-title":"A lecture on vasovagal syncope and the carotid sinus mechanism","author":"Lewis","year":"1932","journal-title":"Br Med J"},{"key":"2020090806034950600_b40","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1056\/NEJM199304153281504","article-title":"Comparison of cardiac pacing with drug therapy in the treatment of neurocardiogenic syncope with bradycardia or hypotension","volume":"328","author":"Sra","year":"1993","journal-title":"N Engl J Med"},{"key":"2020090806034950600_b41","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1111\/j.1540-8159.1994.tb01429.x","article-title":"Short interval VDD pacing does not prevent tilt-induced syncope in patients with cardioinhibitory vasovagal syndrome","volume":"17","author":"Petersen","year":"1994","journal-title":"PACE"},{"key":"2020090806034950600_b42","doi-asserted-by":"crossref","first-page":"204","DOI":"10.7326\/0003-4819-122-3-199502010-00008","article-title":"Cardiac pacing for prevention of recurrent vasovagal syncope","volume":"122","author":"Benditt","year":"1995","journal-title":"Ann Int Med"},{"key":"2020090806034950600_b43","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1097\/00001573-199401000-00007","article-title":"Neurally-mediated syncope with an update in indications and usefulness of head upright tilt table testing and pharmacologic therapy","author":"Kosinski","year":"1994","journal-title":"Curr Opin Cardiol"},{"key":"2020090806034950600_b44","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1161\/01.CIR.92.1.54","article-title":"Provocation of hypotension during head up tilt testing in subjects with no history of syncope or presyncope","volume":"92","author":"Natale","year":"1995","journal-title":"Circulation"},{"key":"2020090806034950600_b45","first-page":"936","article-title":"Long distance runners heart: Is it a condition at risk for malignant vaso-vagal syndrome? (Abstr)","volume":"18","author":"Ferrario","year":"1993","journal-title":"PACE"},{"key":"2020090806034950600_b46","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/0735-1097(96)00236-7","article-title":"Tilt table testing for assessing syncope and its treatment: An American College of Cardiology expert consensus document","volume":"28","author":"Benditt","year":"1996","journal-title":"J Am Coll Cardiol"}],"container-title":["EP Europace"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/europace\/article-pdf\/2\/1\/77\/33724770\/77.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/europace\/article-pdf\/2\/1\/77\/33724770\/77.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,9,8]],"date-time":"2020-09-08T10:04:16Z","timestamp":1599559456000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/europace\/article\/2\/1\/77\/568282"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2000,1,1]]},"references-count":46,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2000,1,1]]},"published-print":{"date-parts":[[2000,1,1]]}},"URL":"https:\/\/doi.org\/10.1053\/eupc.1999.0065","relation":{},"ISSN":["1532-2092","1099-5129"],"issn-type":[{"value":"1532-2092","type":"electronic"},{"value":"1099-5129","type":"print"}],"subject":[],"published-other":{"date-parts":[[2000,1]]},"published":{"date-parts":[[2000,1,1]]}}}