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

Guaraldi, Pietro; Calandra-Buonaura, Giovanna; Terlizzi, Rossana; Cecere, Annagrazia; Solieri, Laura; Barletta, Giorgio; Cortelli, Pietro

doi:10.1007/s10286-011-0153-3

Cited by 13 publications

(12 citation statements)

References 15 publications

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“…In terms of mortality, all studies, including this study with very prolonged asystoles, are consistent with a favorable prognosis, with no reported deaths. It is worth evidencing that in the case of this study, as in other studies in adult populations, the lack of mortality occurred despite a nonaggressive treatment (no pacemaker implantation).…”

Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

“…Few studies have specifically addressed the prognosis of patients with reflex syncope and an asystolic response to HUT test (with asystoles over 3 seconds), but those that did were consistent with a favorable outcome, regardless of the treatment applied (pacemaker, pharmacological treatment, general measures, or no treatment; Table II). [7][8][9][10][11][12][13] These studies included some patients with asystoles greater than 30 seconds and a recent study by Sau et al 14 Syncope recurrence rates vary from study to study (0%/year to 23.3%/year) and probably reflect the fact that it is more dependent on other variables, namely previous number of syncopes, than on the presence of an asystolic response. In this study, recurrence rate was 7.8%/year and, although it clearly reflects a nonnegligible morbidity (with ⅓ of the patients experiencing recurrences at around 4½ years of follow-up), it is important to note that it is no worse than the referred recurrence rate for syncope in general in population studies (approximately 33% at 36 months of follow-up), 1 nor is it consistently worse than the recurrence rate encountered in previous studies with shorter asystoles (Table II).…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Value of a Very Prolonged Asystole during Head‐Up Tilt Test

Carvalho

Santos

Carmo

et al. 2015

Pacing Clinical Electrophis

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A retrospective study was conducted in two centers between January 2003 and December 2013 and included a total of 2,263 consecutive HUT tests (sensitized with isosorbide dinitrate) performed in 2,247 patients with syncope of unknown etiology. Cardioinhibitory response with asystole was observed in 149 (6.6%) of these tests (44.3% women, mean age 37 ± 18 years old, 16.1% in the nonpharmacological phase), with a median duration of asystole of 10 (6-19) seconds. Very prolonged asystole (≥30 seconds) was documented in 11 (0.5%) patients (45% women; mean age 40 ± 19 years; only one in the nonpharmacological phase, 9 minutes after HUT). The longest pause lasted 63 seconds. In all patients, avoidance of triggering factors and physical counterpressure maneuvers were recommended. Telephone follow-up was performed: in one patient, fludrocortisone was started; tilt training was conducted in one patient and none received a pacemaker. After a median follow-up of 42 (30-76) months, four patients (36%) had syncopal recurrences, one patient had a syncope-related injury (scalp laceration), and no patient died.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic Value of a Very Prolonged Asystole during Head‐Up Tilt Test

Carvalho

Santos

Carmo

et al. 2015

Pacing Clinical Electrophis

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“…For example, we observed that asystole period during the cardioinhibitory response could reach 14 sec and extremely over up to 25 sec especially in adult subjects with age among 25-50. Guaraldi et al recently reported that asystole period developed during the HUTT did not lead a poor prognosis in a study population other than frequent syncope episodes in a limited number of subjects (10). Although those long asystole periods did not precede or degenerated to any undesired events in our study, we already recommended the implantation of a pacemaker with the feature of heart rate acceleration to our patients with asystole period longer than 5 sec.…”

Section: Discussionmentioning

confidence: 49%

Gender and age effects on the type of result of head-up tilt-table test: A retrospective study

Yalçın¹,

Aparcı²,

Işılak³

et al. 2015

Gulhane Med J

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ÖZET Eğik masa testi sonuçlarına yaş ve cinsiyetin etkisi: Retrospektif çalışmaBu çalışmada, eğik masa testi yapılan 591 hastanın test sonuçlarını ve klinik özelliklerini geriye dönük olarak incelendik. Eğik masa testi sonuçları [normal, vasovagal senkop (mikst, vazodepresör ve kardiyoinhibitör tip 2A ve 2B)] ve asistol süreleri, yaş grupları (<25, 25-50, >50 yaş) ve cinsiyete göre karşılaştırıldı. Mikst tip ve vazodepresör tip vasovagal senkop en çok tespit edilen cevap tipleriydi [Sırasıyla 140(%23.7) ve 76(%12.9)]. Vazodepresör, kardiyoinhibitör tip 2A ve 2B vasovagal senkop daha ileri yaşlarda (>50 yaş) biraz daha fazla tespit edilirken, mikst tip vasovagal senkop en çok daha genç yaşlarda (<25 yaş) tespit edildi (p=0.652). En çok gözlenen asistol süresi olan 3-6 saniye, daha genç yaşlarda gözlenirken, bu süre daha yetişkinlerde (25-50 yaş) 7-8 saniye ve üzerine uzadığı görüldü (p=0.285). Cinsiyet açısından tek fark olarak kadınlarda vazodepresör tip vasovagal senkop hafif fazla (P=0.153), erkeklerde asistol daha sık gözlendi (P=0.709). Eğik masa testi tüm yaş gruplarında uygun şartlarda kolayca uygulanabilen bir testtir. Mikst tip vasovagal senkop en çok tespit edilen tanı olmasına rağmen kardiyoinhibitör tip vasovagal senkop da tüm yaş gruplarında nadir olmayan sonuçlardan biridir. 3-6 saniye süreli asistol genellikle daha gençlerde gözlenirken bu süre daha yaşlılarda komplikasyon gelişmeden 7-8 saniyeye kadar uzayabildi. Anahtar Kelimeler: Eğimli masa testi; vasovagal senkop; asistol; aritmi, SUMMARY In this study we analyzed retrospectively the results of head-up tilt-table test (HUTT) and clinical features of 591 subjects. The head-up tilt-table test results [normal, vasovagal syncope (mixed, vasodepressor and cardioinhibitory type 2A and 2B)] and the asystole periods were compared by age groups (<25, 25-50, >50 years old) and gender. Mixed type and vasodepressor type vasovagal syncope were the predominant types of response [140 (23.7%) and 76 (12.9%), respectively]. Mixed type vasovagal syncope was higher in younger ages (<25 years) whereas vasodepressor and cardioinhibitory type 2A and 2B type vasovagal syncope was slightly higher in older ages (>50 years) (p=0.652). While the mostly observed asystole period was 3-6 sec and over in younger ages, it may prolong 7-8 sec and over in adults (25-50 years old) (p=0.285). The only difference with regard to gender was that the rate of vasodepressor type was slightly higher in females (P=0.153) whereas asystole period was more frequently observed in males (P=0.709). Head-up tilt-table test is a convenient and easily applicable test in proper circumstances for all age groups. Although mixed type vasovagal syncope is a predominant diagnosis in the test, cardioinhibitory type vasovagal syncope is not an infrequent one in all age groups. While asystole period of 3-6 sec was mainly observed in younger patients, it was prolonging over 7-8 sec in older ages without any complication.

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“…Despite the benign course of vasovagal syncope, without mortality, there is recurrence of syncope in these patients with cardioinhibitory response from 9% to 62.5% during follow up 24 to 77 months [15, 17, 18, 23, 24]. An interesting observation is that heart rhythm during the episode of recurrence is identical to the first spontaneous syncope [25].…”

Section: Cardioinhibitory Vasovagal Syncopementioning

confidence: 99%

The Current Indication for Pacemaker in Patients with Cardioinhibitory Vasovagal Syncope

Silva

Lisboa²

2016

TOCMJ

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The most frequent cause of syncope is vasovagal reflex. It is associated with worse quality of life, depression, fatigue and physical injury. Recurrence of vasovagal syncope is an aggravating, reaching the rate of 69%. Initial step and pharmacological treatment may not work, especially in patients with recurrent syncope without prodrome. These patients can present cardioinhibitory response with asystole. Studies were designed to analyses the effectiveness of pacemaker for prevention of syncope. In this review, nonrandomized clinical trials, open-label randomized, double-blind randomized, placebo-controlled, and studies based on tilt test or Implantable Loop Recorder findings will be discussed.

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

Abstract: Although syncopal recurrences were common, tilt-induced asystole did not imply a poor prognosis in terms of death or major therapeutic procedures.

Cited by 13 publications

References 15 publications

Prognostic Value of a Very Prolonged Asystole during Head‐Up Tilt Test

Prognostic Value of a Very Prolonged Asystole during Head‐Up Tilt Test

Gender and age effects on the type of result of head-up tilt-table test: A retrospective study

The Current Indication for Pacemaker in Patients with Cardioinhibitory Vasovagal Syncope

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