Head-up Tilt Test

Englund, Anders; Fredrïkson, Mia; Rosenqvist, M

doi:10.1161/01.cir.95.4.951

Cited by 12 publications

(4 citation statements)

References 25 publications

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“…Nevertheless, in 4 patients who had a documented relapse, the type of response during tilt testing was different from the spontaneous episode and the sudden onset of the spontaneous episode was in contrast with the modality of onset of the patients with neurally mediated syncope, as discussed above. 7 Therefore, our results confirm the concern raised in previous studies 8,9 regarding the low specificity of tilt testing in patients with BBB.…”

Section: Discussionsupporting

confidence: 90%

“…Therefore, patients with both BBB and a positive response to tilt testing were included, because the specificity of a positive response to tilt testing has raised serious concern, and, in that, positivity cannot exclude a cardiac cause of syncope. 8,9 The electrophysiological study included measurement of the sinus node recovery time; measurement of the HV interval at the baseline and under stress by incremental atrial pacing and, if the baseline study was inconclusive, pharmacological provocation with slow infusion of ajmaline (1 mg/kg IV); assessment of the inducibility of ventricular arrhythmia by means of programmed ventricular stimulation; and assessment of the inducibility of supraventricular arrhythmia by any atrial stimulation protocol. In accordance with the literature, 1,10 -16 the electrophysiological study was considered diagnostic, and, therefore, the patients were excluded from the study in the following cases: (1) sinus bradycardia and abnormal sinus node recovery time; (2) baseline HV interval of Ն70 ms, 2nd or 3rd degree His-Purkinje block demonstrated during incremental atrial pacing, or high-degree His-Purkinje block elicited by intravenous administration of ajmaline; (3) induction of sustained monomorphic ventricular tachycardia; or (4) induction of rapid supraventricular arrhythmia, which reproduced hypotensive or spontaneous symptoms.…”

Section: Study Protocolmentioning

confidence: 99%

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Mechanism of Syncope in Patients With Bundle Branch Block and Negative Electrophysiological Test

Brignole¹,

Menozzi²,

Moya³

et al. 2001

Circulation

297

119

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on behalf of the International Study on Syncope of Uncertain Etiology (ISSUE) Investigators* Background-In patients with syncope and bundle branch block (BBB), syncope is suspected to be attributable to a paroxysmal atrioventricular (AV) block, but little is known of its mechanism when electrophysiological study is negative. Methods and Results-We applied an implantable loop recorder in 52 patients with BBB and negative conventional workup. During a follow-up of 3 to 15 months, syncope recurred in 22 patients (42%), the event being documented in 19 patients after a median of 48 days. The most frequent finding, recorded in 17 patients, was one or more prolonged asystolic pause mainly attributable to AV block; the remaining 2 patients had normal sinus rhythm or sinus tachycardia. The onset of the bradycardic episodes was always sudden but was sometimes preceded by ventricular premature beats. The median duration of the arrhythmic event was 47 seconds. An additional 3 patients developed nonsyncopal persistent III-degree AV block, and 2 patients had presyncope attributable to AV block with asystole. No patients suffered injury attributable to syncopal relapse. Conclusions-In patients with BBB and negative electrophysiological study, most syncopal recurrences have a homogeneous mechanism that is characterized by prolonged asystolic pauses, mainly attributable to sudden-onset paroxysmal AV block.

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Section: Discussionsupporting

confidence: 90%

Section: Study Protocolmentioning

confidence: 99%

Mechanism of Syncope in Patients With Bundle Branch Block and Negative Electrophysiological Test

Brignole¹,

Menozzi²,

Moya³

et al. 2001

Circulation

297

119

View full text Add to dashboard Cite

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“…10,[13][14][15][16][17][18] Therefore, the current evidence led the American College of Cardiology-American Heart Association-Heart Rhythm Society (ACC-AHA-HRS) committee to consider permanent pacemaker implantation as a class IIA indication for BFB patients presenting with syncope of undetermined origin. 11,12,19 However, the guidelines do not state which pacing modality should be chosen for these patients (single versus dual chamber).…”

Section: Circ Arrhythm Electrophysiolmentioning

confidence: 99%

Prevention of Syncope Through Permanent Cardiac Pacing in Patients With Bifascicular Block and Syncope of Unexplained Origin

Santini

Castro

Giada

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Background— Syncope in patients with bifascicular block (BFB) is a common event whose causes might be difficult to assess. Methods and Results— Prevention of syncope through permanent cardiac pacing in patients with bifascicular block (PRESS) is a multicenter, prospective, randomized, single-blinded study designed to demonstrate a reduction in symptomatic events in patients with bifascicular block and syncope of undetermined origin implanted with permanent pacemaker. Device programming mode (NASPE/BPEG code) at DDD with a lower rate of 60 ppm is compared with backup pacing at DDI with a lower rate of 30 ppm. The end point consisted of (1) syncope, (2) symptomatic presyncopal episodes associated with a device intervention (ventricular pacing), and (3) symptomatic episodes associated with intermittent or permanent atrioventricular block (any degree). One hundred one patients were enrolled and randomized. Primary end point events at 2 years were observed in 23 patients, with a significant lower incidence in the study group (hazard ratio, 0.32; 95% confidence interval [CI], 0.10–0.96; P =0.042). Reduction of any symptoms, associated or not with device intervention, was superior in DDD60 compared with DDI30 (hazard ratio, 0.4; 95% confidence interval, 0.25–0.78; P =0.0053). Fourteen patients developed other rhythm diseases and met class I indication for pacing. The annual incidence of rhythm disease development was 7.4%. Conclusions— In patients with bifascicular block and syncope of undetermined origin, the use of a dual chamber pacemaker programmed to DDD60 led to a significant reduction of syncope or symptomatic events associated with a cardioinhibitory origin, compared with DDI30 programming. Symptoms associated with a new onset of rhythm disease were found in 15% of the population at 2 years.

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“…Benign causes of syncope, such as an abnormal neurally mediated reflex, could be one of the explanations for the syncopal attacks without documented bradycardia. Neurally mediated syncope is not uncommon in the BFB population as reported by Donateo et al [20] but the method of making this diagnosis is difficult since the reliability of the head-up tilt test has been questioned in BFB patients [21, 22]. …”

Section: Discussionmentioning

confidence: 99%

Time Relation between a Syncopal Event and Documentation of Atrioventricular Block in Patients with Bifascicular Block: Clinical Implications

et al. 2006

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Background: Transient high-degree atrioventricular (AV) block is a common cause of syncope in patients with bifascicular block (BFB) but the intermittent nature of AV block makes ECG documentation a challenge. A sensitive and safe tool to investigate BFB patients with syncope would be a bradycardia-detecting pacemaker, which provides a possibility of studying the time relation between the index syncopal episode and the development of high-degree AV block. Methods: Twenty-seven patients with BFB and syncope were studied prospectively. All patients received a single-chamber ventricular-based pacemaker with bradycardia-detecting ability. A bradycardia episode was defined as a heart rate of <30 beats/min lasting ≧6 s. Results: During a median follow-up of 60 months, a bradycardia event was detected in 14 patients (52%), of whom 13 also had documented high-degree AV block on ECG. The median time between the syncopal episode and the first pacemaker-detected bradycardia event was 5 months and after an additional median time of 6 months, high-degree AV block was documented on the ECG. In 10 of 13 patients (77%) high-degree AV block was documented within 24 months of the syncopal episode corresponding to an annual incidence of 19% during the first 2 years of follow-up in the study population. Conclusion: In this group of BFB patients a syncopal episode was highly predictive of the development of high-degree AV block within 24 months, justifying pacemaker therapy without prior ECG verification.

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Head-up Tilt Test

Abstract: This study gives rise to serious concern regarding the specificity of the head-up tilt test in patients with bifascicular block. A head-up tilt test should therefore be interpreted with caution, and its role as a diagnostic tool in this patient category remains to be established.

Cited by 12 publications

References 25 publications

Mechanism of Syncope in Patients With Bundle Branch Block and Negative Electrophysiological Test

Mechanism of Syncope in Patients With Bundle Branch Block and Negative Electrophysiological Test

Prevention of Syncope Through Permanent Cardiac Pacing in Patients With Bifascicular Block and Syncope of Unexplained Origin

Time Relation between a Syncopal Event and Documentation of Atrioventricular Block in Patients with Bifascicular Block: Clinical Implications

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