Clinical usefulness of head-up tilt test in patients with syncope and intraventricular conduction defect (original) (raw)
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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 ...
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)
Indian pacing and electrophysiology journal, 2013
This randomized study was aimed to compare the diagnostic value of two head-up tilt testing protocols using sublingual nitroglycerin for provocation in patients with recurrent unexplained syncope and normal heart. The patients with normal findings in physical examination, electrocardiography and echocardiography were randomly submitted to one of upright tilt test protocols. The only difference between two protocols was that nitroglycerin was administered after a five minute resting phase in supine position during protocol B. We also considered eighty normal persons as the control group. Out of 290 patients that underwent tilt testing, 132 patients were in group A versus 158 patients in group B. Both groups had an identical distribution of clinical characteristics. Tilt test was positive in 79 patients in group A (25 in passive phase, 54 in active phase) versus 96 patients in group B (43 in passive phase, 53 in active phase). There was no significant difference between results in two...
Reproducibility of head-up tilt test in patients with syncope
Clinical Cardiology, 1996
As the head-up tilt test (HUT) is employed to verify the efficacy of undertaking a treatment, we prospectively evaluated the reproducibility of positive and negative results, as well as that of the response type in 64 consecutive patients (mean age 34.6 ± 22.9 years) with syncope of unknown cause. Two HUTs (60 min, 75° ), separated by an interval of 9.77 ± 8.21 days, were performed on each patient. Positive responses were reproduced in the second HUT in 54.5% of the patients. A greater reproducibility (84.3%) was observed for negative responses. Of the 31 patients with a negative first test, 5 had a positive response during the second HUT. Using a multivariate analysis, no clinical variable correlated with the reproducibility of positive or negative results. Likewise, neither arterial pressure nor heart rate observed during the test were correlated with reproducibility. Of 18 patients who reproduced positive responses, 12 (66.6%) did so with the same response modality. In three patients with documented monomorphic sustained ventricular tachycardia, which was hemodynamically well tolerated, and in one patient with temporal spike wave activity in the electroencephalogram, HUT was also positive. It was concluded that the low reproducibility of HUT limits its usefulness as a tool for evaluating treatment efficacy. The variability of the type of response suggests a common mechanism leading to cardioinhibitory and vasodepressor reactions. A positive result in only the second study shows the rationale of performing two tests when the first one is negative.
Sensitivity and Specificity of the Tilt Table Test in Young Patients with Unexplained Syncope
Pacing and Clinical Electrophysiology, 1993
The use/uJness of the head-up tilt testing (HUT) has heen previously addressed in diagnosing vasovagal neuroregulatory syncope in (he teenage population. However, data concerning sensitivity and specificity is deficient due to the lack of control groups. We compared the response to HUT in young patients re/erred because of syncope or near syncope fn -44, mean age 16 ± 3 years SD) to healthy young voJunteers with a normal physical examination and no previous history of syncope (n -18, mean age 16 ± 2 years) and io determine the sensitivity and specificity of HUT. The graded tilt protocol was performed at 15°, 30°, and 45° (each for 2 min), and then 60" for 20 minutes. Cuff blood pressure was measured every minute and lead II ECG was continuously monitored. Results; 25 of the 44 patients (57%) developed a vasovagaJ response or became symptomatic after 13.8 ± 5.7 minutes of HUT. Three of the 18 volunteers (17%) had a vasovagal response and became symptomatic after 9 ± 3 minutes of HUT. There was no statistical difference among the four groups (with and without tilt induced vasovagal response) in terms of age and baseline hemodynamic data. The sensitivity of 20 minutes HUT was 57% and its specificity was 83%. The presyncopal hemodynamic response in patients with history of syncope that was characterized by a significant decrease in systolic blood pressure and lack of increase of diastolic blood pressure as compared with baseline and with other groups. Gonclusions: 20 minutes at 60° HUT has a high specificity for the diagnosis of vasovagal syncope. Its limited sensitivity is counterbalanced by the advantage of limiting the incidence of false-positive results in patients without the vasovagal syndrome. (PACE, VoJ. 16, March, Part I 1993) tilt table test, syncope, teenagers, sensitivity, specificity Address for reprints: Fetnat M. Fouad, M.D., Department of Heart & Hypertension Research. 9500 Euclid Ave. (FFl-02b), Cleveland, OH 44195. Fax: (216) 444-9263.
Electrophysiologic testing in the evaluation of patients with syncope of undetermined origin
The American Journal of Cardiology, 1982
was undertaken to assess the value of comprehensive invasive electrophysiologic techniques in patients with syncope but no discernible cause after thorough medical and neurologic evaluation. The study was designed to detect both bradyarrhythmias and previously unsuspected supraventricufar and ventricular tachyarrhythmias with invasive electrophysiologic methods. Methods Clinical evaluation and characteristics: Thirty-two patients with syncope referred to the Cardiology Service of the University of California Medical Center from January 1, 1979 to October 1, 1980 were evaluated with conventional medical and neurologic techniques. Syncope was defined as a clinical syndrome characterized by abrupt, transient loss of consciousness with inability to maintain postural tone. All patients underwent a complete medical history, physical examination, and routine laboratory testing. Postural vital signs were recorded in all patients, and individual right and left carotid sinus massage was performed during continuous electrocardiographic (ECG) monitoring. The history was reviewed with special emphasis on the situation and environment at the time of syncope, and, when possible, witnesses to the episode were interviewed. Neurologic consultation was
Head-upright tilt table testing for recurrent, unexplained syncope
Clinical Cardiology, 1993
Recurrent episodes of unexplained syncope are a common and often frustrating problem for the practicing physician. Although vasovagally mediated episodes of hypotension and bradycardia have been felt to be a common cause of these idiopathic events, traditionally this was a diagnosis of exclusion. Recently, head-upright tilt table testing has emerged as a method both for confirming the diagnosis of vasovagal syncope and for better understanding the mechanisms by which these events occur. This paper reviews current understanding of the pathophysiology of vasovagal syncope, the development and role of head-upright tilt table testing in its evaluation, and potential therapeutic modalities that can be helpful for the prevention of recurrent episodes.
Long-Term Follow-Up of Patients with Syncope Evaluated by Head-Up Tilt Test
Annals of Noninvasive Electrocardiology, 2010
Background: Clinicians may be tempted to consider a positive head-up tilt test (HUTT) an unfavorable prognostic indicator. We investigated whether results of routine HUTT predict long-term recurrence of syncope. Methods: We analyzed syncope recurrence at long-term among 107 patients (mean age 51 ± 20 years) receiving HUTT for diagnostic evaluation of unexplained/suspected neurocardiogenic syncope in our Institute. Results: HUTT was positive in 76 patients (vasodepressive response, n = 58; cardioinhibitory, n = 5; mixed, n = 13). During a median follow-up of 113 months (range, 7-161), 34 (32%) patients experienced recurrence (24 [32%] with positive HUTT during 110 months (7-159); 10 [32%] with negative HUTT during 120 [22-161] months). Actuarial freedom from recurrence at 10 years did not significantly differ for patients with positive/negative test results (after passive/active phases) or with different positive response patterns (vasodepressive, cardioinhibitory, mixed). By contrast, history of >4 syncopes in the 12 months preceding HUTT stratified risk of recurrence, irrespective of HUTT positivity/negativity. At Cox proportional hazards analysis, history of >4 syncopes in the 12 months preceding HUTT was the single independent risk factor for recurrence both in the overall study population (HR, 1.7; 95% CI, 1.07-2.69) and within the subset of patients who tested positive (HR, 1.83; 95% CI, 1.07-3.17). Conclusions: This long-term follow-up study reinforces the concept that a positive HUTT should not be considered an unfavorable prognostic indicator; frequency of recent occurrences may be a more valid predictor. Ann Noninvasive Electrocardiol 2010;15(2):101-106 syncope; tilt-table test; prognosis The head-up tilt test (HUTT) is a useful final diagnostic test for patients with unexplained or suspected neurocardiogenic syncope. 1,2 Even though the prognosis of reflex syncope is generally favorable, the ability to predict recurrence is relevant in this clinical setting to help maintain patients' quality of life.