Long-term outcome of patients with asystole induced by head-up tilt test (original) (raw)
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Asystole during Tilt Testing-Induced Syncope: A Long-Term Follow-Up
Journal of Clinical Cardiology, 2021
Background: Tilt-table testing is safe and low-risk, but asystole of variable duration may be tilt-induced and, it was suggested that it could represent a life-threatening manifestation of vasovagal syncope. We performed a retrospective observational study evaluating the clinical characteristics and long-term outcome in patients with asystole during tilt-induced syncope. Methods: A cohort of 552 patients referred for evaluation of recurrent syncope of unknown etiology underwent to a modified passive and active protocol tilt-table testing. Results: 68% were positive to neurally mediated reflex syncope with 41 (11%) cases of asystole. Twenty-eight women (68%), mean age 26 ± 13 years and thirteen men, 31 ± 7 years had syncope with asystolic pause ≥ 3 seconds during baseline, 27 of 41 (66%) or pharmacological challenge test, 14 of 41 (34%). The mean duration of asystole was 12.6 ± 11.3 seconds and, 80% of cases had sinus arrest ≥ 5 seconds. 32 of 41 (78%) patients were successfully followed-up during a mean of 5.3 ± 1.5 years (range 1.5 to 8); 87.5% of patients had ≥ 5 years of follow-up. Therapy was not guided based on the results of tilt-table testing and pharmacologic therapy with β-blockers was generally effective. During long-term follow-up, only 12.5% had syncope recurrence and in 37.5% drugs were withdrawn after a long asymptomatic period. Conclusion: Asystole during tilt-induced syncope does not necessarily predict adverse outcomes with most patients having a benign clinical course and improving with lifestyle changes and pharmacologic therapy and even spontaneously over a long-term follow-up.
Circulation. Arrhythmia and electrophysiology, 2014
In the Third International Study on Syncope of Uncertain Etiology (ISSUE-3), cardiac pacing was effective in reducing recurrence of syncope in patients with presumed neurally mediated syncope (NMS) and documented asystole but syncope still recurred in 25% of them at 2 years. We have investigated the role of tilt testing (TT) in predicting recurrences. In 136 patients enrolled in the ISSUE-3, TT was positive in 76 and negative in 60. An asystolic response predicted a similar asystolic form during implantable loop recorder monitoring, with a positive predictive value of 86%. The corresponding values were 48% in patients with non-asystolic TT and 58% in patients with negative TT (P=0.001 versus asystolic TT). Fifty-two patients (26 TT+ and 26 TT-) with asystolic neurally mediated syncope received a pacemaker. Syncope recurred in 8 TT+ and in 1 TT- patients. At 21 months, the estimated product-limit syncope recurrence rates were 55% and 5%, respectively (P=0.004). The TT+ recurrence rat...
Asystolic Cardiac Arrest During Head-Up Tilt Test: Incidence and Therapeutic Implications
Pacing and Clinical Electrophysiology, 1997
Asystolic Cardiac Arrest during Head-Up Tilt Test: Incidence and Therapeutic Implications. Occasionally, the cardioinhibitory response may be profond during tilt induced syncope. Whether this response is associated with more severe symptoms or predicts a poor response to pharmacotherapy remains controversial. The aim of this study was to characterize patients with vasovagally mediated asystole occurring during head-up tilt test and to evaluate the respective interests of sequential pacing and ^-Mockers to treat them. We performed 60° tilt testing in 179 consecutive patients with unexplained syncope (91 women and 88 men, age 36.6 ± 20.1 years). Asystole was defined as a ventricular pause > 5 seconds. AH patients with tilt induced asystole received therapy with either ^-Mockers or sequential pacing, the efficacy of which was evaluated with serial tilt tests. Of 77 patients with positive tilt test, 10 developed syncope related to asystole (mean duration 11.9 ± 4.9 s), 2 with spontaneous recovery, and 8 with seizures needing a brief cardiopulmonary resuscitation. When compared with patients without asystole, asystolic patients had more severe symptoms (seizures: 6/10 vs 9/67, P = 0.05, injury: 9/10 vs 27/67, P = 0.0048). In the first six patients in whom cardiac pacing was considered, syncope or presyncope still occurred despite atrioventricular pacing at 45 beats/min. Five of these 6 patients, as well as the remaining 4 asystolic patients, were tilted with ji-biockers: 3 patients became tilt-negative; 3 were significantly improved; and 3 did not respond. During follow-up (mean 22.7 ± 11.7 months) with every patient taking (3-b!ockers and seven having a permanent pacemaker, no syncopal recurrence was observed. Tiltinduced asystole that may require resuscitative maneuvers occurs especially in patients with a history of seizures or injury. Therapy with (i-blockers is often effective to prevent induction of syncope as well as recurrences.
Diagnostic value of the head-up tilt test and the R-test in patients with syncope
Heart International, 2006
The diagnostic value of the head-up tilt test (HUTT) in discovering vasovagal syndrome depends on the pre-test probability. An accurate anamnesis and clinical examination screens the patients indicated for the HUTT. In patients with unexplained syncope, the R-test is an alternative procedure to discover its cause. In our study, we evaluated the diagnostic significance of the HUTT in a group of 211 patients and of the R-test in a subgroup of 45 patients with negative HUTT results and with negative traditional Holter ECG monitoring (24 hr). (Heart International 2006; 3-4: 171-7)
Diagnostic utility of the head-up tilt test in syncope and the related complications
2017
Background: Recurrent syncope is a distressing symptom in which the cause may remain undetermined. A definitive diagnosis may help the patients to lead a normal life and avoid the unnecessary risk to their lives. Objective: To evaluate the effectiveness and safety of Head up Tilt Test (HUTT) in patients with undiagnosed syncope and to detect and follow up any complications arising out of the procedure. Material and methods: The head up tilt table test was performed in department of cardiology. 72 patients with a history of syncope or presyncope underwent upright tilt table testing to exclude vasovagal syncope, with baseline tilt and if negative followed by progressively increasing doses of isoprenaline infusion. 70° tilt was used and continuous heart rate and non-invasive BP recordings were made every 2 minutes or earlier when symptomatic. Results: The mean age of the patients was 48±16 years. None of the patients had carotid sinus hypersensitivity. Forty-five patients (62.5%) were ...
Cardiac pacing in severe recurrent reflex syncope and tilt-induced asystole
European Heart Journal, 2020
Aim The benefit of cardiac pacing in patients with severe recurrent reflex syncope and asystole induced by tilt testing has not been established. The usefulness of tilt-table test to select candidates for cardiac pacing is controversial. Methods and results We randomly assigned patients aged 40 years or older who had at least two episodes of unpredictable severe reflex syncope during the last year and a tilt-induced syncope with an asystolic pause longer than 3 s, to receive either an active (pacing ON; 63 patients) or an inactive (pacing OFF; 64 patients) dual-chamber pacemaker with closed loop stimulation (CLS). The primary endpoint was the time to first recurrence of syncope. Patients and independent outcome assessors were blinded to the assigned treatment. After a median follow-up of 11.2 months, syncope occurred in significantly fewer patients in the pacing group than in the control group [10 (16%) vs. 34 (53%); hazard ratio, 0.23; P = 0.00005]. The estimated syncope recurrence...