{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T02:53:45Z","timestamp":1770778425589,"version":"3.50.0"},"reference-count":21,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2021,9,19]],"date-time":"2021-09-19T00:00:00Z","timestamp":1632009600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>In patients with ictal asystole (IA) both cardioinhibition and vasodepression may contribute to syncopal loss of consciousness. We investigated the temporal relationship between onset of asystole and development of syncope in IA, to estimate the frequency with which pacemaker therapy, by preventing severe bradycardia, may diminish syncope risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this retrospective cohort study, we searched video\u2010EEG databases for individuals with focal seizures and IA (asystole\u2009\u2265\u20093\u2009s preceded by heart rate deceleration) and assessed the durations of asystole and syncope and their temporal relationship. Syncope was evaluated using both video observations (loss of muscle tone) and EEG (generalized slowing\/flattening). We assumed that asystole starting \u22643\u2009s before syncope onset, or after syncope began, could not have been the dominant cause.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 38 seizures with IA from 29 individuals (17 males; median age: 41 years). Syncope occurred in 22\/38 seizures with IA and was more frequent in those with longer IA duration (median duration: 20 [range: 5\u201332] vs. 5 [range: 3\u20139]\u2009s; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and those with the patient seated vs. supine (79% vs. 46%; <jats:italic>p<\/jats:italic>\u2009=\u2009.049). IA onset always preceded syncope. In 20\/22 seizures (91%), IA preceded syncope by &gt;3\u2009s. Thus, in only two instances was vasodepression rather than cardioinhibition the dominant presumptive syncope triggering mechanism.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In IA, cardioinhibition played an important role in most seizure\u2010induced syncopal events, thereby favoring the potential utility of pacemaker implantation in patients with difficult to suppress IA.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.15239","type":"journal-article","created":{"date-parts":[[2021,9,12]],"date-time":"2021-09-12T17:18:10Z","timestamp":1631467090000},"page":"3019-3026","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Timing of syncope in ictal asystole as a guide when considering pacemaker implantation"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1987-5793","authenticated-orcid":false,"given":"Anouk","family":"van Westrhenen","sequence":"first","affiliation":[{"name":"Stichting Epilepsie Instellingen Nederland (SEIN) Zwolle The Netherlands"},{"name":"Department of Neurology and Clinical Neurophysiology Leiden University Medical Center (LUMC) Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon","family":"Shmuely","sequence":"additional","affiliation":[{"name":"Stichting Epilepsie Instellingen Nederland (SEIN) Zwolle The Netherlands"},{"name":"NIHR University College London Hospitals Biomedical Research Centre UCL Queen Square Institute of Neurology  London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rainer","family":"Surges","sequence":"additional","affiliation":[{"name":"Department of Epileptology University of Bonn Medical Center Bonn Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beate","family":"Diehl","sequence":"additional","affiliation":[{"name":"NIHR University College London Hospitals Biomedical Research Centre UCL Queen Square Institute of Neurology  London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Friedman","sequence":"additional","affiliation":[{"name":"NYU Department of Neurology New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frans S. S.","family":"Leijten","sequence":"additional","affiliation":[{"name":"Department of Neurophysiology University Medical Center Utrecht (UMCU) Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorien","family":"van Hoey Smith","sequence":"additional","affiliation":[{"name":"Stichting Epilepsie Instellingen Nederland (SEIN) Zwolle The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8511-6920","authenticated-orcid":false,"given":"David G.","family":"Benditt","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Cardiac Arrhythmia Center University of Minnesota Medical School Minneapolis Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Gert","family":"van Dijk","sequence":"additional","affiliation":[{"name":"Department of Neurology and Clinical Neurophysiology Leiden University Medical Center (LUMC) Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1435-8970","authenticated-orcid":false,"given":"Roland D.","family":"Thijs","sequence":"additional","affiliation":[{"name":"Stichting Epilepsie Instellingen Nederland (SEIN) Zwolle The Netherlands"},{"name":"Department of Neurology and Clinical Neurophysiology Leiden University Medical Center (LUMC) Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,9,19]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"69","article-title":"Cardiac arrhythmias during or after epileptic seizures","volume":"87","author":"Van der Lende M","year":"2016","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13644"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.4997\/JRCPE.2019.209"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.114.002546"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.114.001667"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2011.08.008"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy037"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13009"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2010.02972.x"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2017.07.006"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2020.00036"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2019.10.009"},{"key":"e_1_2_8_14_1","first-page":"1161","article-title":"Novel methods for quantification of vasodepression and cardioinhibition during tilt\u2010induced vasovagal syncope","volume":"10","author":"Dijk JG","year":"2020","journal-title":"Circ Res"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneurpsyc.1943.02290230022002"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awp179"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awt332"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000004266"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12074"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2010.02961.x"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/124.12.2361"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euaa310"}],"container-title":["Journal of Cardiovascular Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jce.15239","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jce.15239","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jce.15239","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T09:29:37Z","timestamp":1693214977000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jce.15239"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,19]]},"references-count":21,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1111\/jce.15239"],"URL":"https:\/\/doi.org\/10.1111\/jce.15239","archive":["Portico"],"relation":{},"ISSN":["1045-3873","1540-8167"],"issn-type":[{"value":"1045-3873","type":"print"},{"value":"1540-8167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,19]]},"assertion":[{"value":"2021-07-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-08-31","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-09-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}