Relevance of asystole during head-up tilt testing (original) (raw)

1995, American Journal of Cardiology

The prognosis of patients manifesting prolonged asyslob during head-up tilt testing is unclear. In 209 consecutlve patients with a history of syncope and pasitive head-up tilt tests, 19 had asystale lasting >5 seconds (mean duration 15 + 10) (group la). When compared with patients without asystale (group l b), group l a patients were younger (32 + 12 vs 47 _+ 21 years, p <0.005), but clinical manifestations were not any more dramatic (the number of episodes of syncope [7 _+ 5 vs 8 + 6 episodes, p = NS] and injury during syncope [2 vs 13 patients, p = NS] were similar). During follow-up (mean 2 + 1 year), with the patient taking pharmacologic therapy such as 13 blockers, ephedrine, Iheophylline, or disopymmide, the recurrence rate was 11% and 8% in groups la and lb (p = NS). No patient in the asystole group underwent pacemaker implantation. Additionally, of 75 normal volunteers (group 2) with no history of syncope undergoing tilt tests to define its specificity, 3 had asystale (mean duration 10 seconds). During >1 year of follow-up, despite no treatment, all 3 are symptom free. Thus, asystale during head-up tilt testing does not predict eilher a more malignant outcome or a poor response to pharmacologic therapy. Moreover, an asystalic response does nat enhance the specificity of the head-up tilt test because it may be present in asymptomatic "normal" volunteers.