Tilt-induced asystole: a useful prognostic marker or clinically unrelevant finding?

Tilt-induced cardioinhibitory syncope: a follow-up study in 16 patients

“…The ten patients who reported persistence of syncopal episodes described them as clinically similar to those recorded during tilt. Furthermore, even if the overall positive rate for vasovagal episodes (with and without asystole) in our cohort was only 13%, the incidence for asystole observed in our study (12%) is comparable to previous results during passive tilt [4,12]. Therefore, even if we are aware of the limitations of our study (such as the small number of patients, the use of telephonic interview and the wide range of follow-up duration) we can conclude that tiltinduced asystole does not imply a poor prognosis in terms of syncopal recurrences or sudden death and that pacing, even in the presence of asystole of more than 3 s appears not justified by currently available data.…”

“…In tilt-table studies, asystole of over 3-5 s occurs in 15% of patients, with a range from 4 to 33%. The incidence was higher during nitrate provocation test (21%) than during passive head-up tilt test (14%) [4]. Up to now only two papers specifically examined the outcome of tilt-induced asystole in adult patients [5] and pediatric population [6] and the exact clinical and prognostic significance of this condition is still a matter of debate [7].…”

Analysis of Heart Rate Variability Before and During Tilt Test in Patients with Cardioinhibitory Vasovagal Syncope

“…7-9 Trauma secondary to syncope occurred in 20% of the case group with exclusively vasovagal syncope, while in the literature that ranged from 27.5% to 29% in a heterogeneous group (vasovagal and of unexplained origin). Prodromes, which are important in clinical history, occurred in 95% of the case group in the present study, being frequently reported in the literature, mainly among young indivduals.…”

“…6 The incidence of that response varies from 1 to 4.4% of the positive tests, reaching 21% in protocols sensitized with nitroglycerin and 13% in protocols sensitized with isoproterenol, being more frequent in young individuals. 7-9 …”

Der Patient mit Synkope

“…Die Rate falsch positiver Tests bei "Normalpersonen" beträgt zwischen < 10% und 15% [29][30][31]. Baron-Esquivias et al [32] kamen bei einer Nachbeobachtungszeit von 40,7 Monaten zu dem Ergebnis, dass die Auslösung einer Asystolie im Tilt-Test keinen "malignen" Ausgang bedeutet, wenn als Kriterium die synkopenfreie Zeit zugrunde gelegt wird.…”