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Is Tilt Testing Really Useful for Selecting Vasovagal Therapy?

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Cardiac Arrhythmias 1997

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Abstract

Head-up tilt test (HUT) was first described as a diagnostic tool for vasovagal syncope (VVS) in 1986 by Kenny et al. [1]. Since then, interest surrounding the test has increased dramatically, and it has been extended not only for diagnostic purposes but also in the management of patients with VVS. Most patients with VVS do not need to be treated, but in selected patients, with recurrent and severe episodes, treatment can be warranted.

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References

  1. Kenny RA, Bayliss J, Ingram A, Sutton R (1986) Head-up tilt test: a useful test for investigating unexplained syncope. Lancet 1: 1352–1354

    Article  PubMed  CAS  Google Scholar 

  2. Fitzpatrick A, Theodorakis G, Vardas P et al (1991) The incidence of malignant vaso-vagal syndrome in patients with recurrent syncope. Eur Heart J 12: 389–394

    PubMed  CAS  Google Scholar 

  3. Almquist A, Goldenberg IF, Milstein S et al (1989) Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope. N Eng J Med 320: 346–351

    Article  CAS  Google Scholar 

  4. Strasbreg B, Rechavia E, Sagie A et al (1989) The head-up tilt table test in patients with syncope of unknown origin. Am Heart J 118: 923–927

    Article  Google Scholar 

  5. Grubb BP, Temesy-Armos P, Hahn H, Elliot L (1991) Utility of upright tilt table test in the evaluation and management of syncope of unknown origin. Am J Med 90: 6–10

    Article  PubMed  CAS  Google Scholar 

  6. Moya A, Permanyer Miralda G, Sagristâ J, Mont L, Rius T, Soler Soler J (1993) Anâlisis de las respuestas a la prueba en tabla basculante en función de las características clínicas de los episodios sincopales en pacientes sin cardiopatia aparente. Rev Esp Cardiol 46: 214–219

    Google Scholar 

  7. Natale A, Akhtar M, Jayazery M et al (1995) Provocation of hypotension during head-up tilt testing in subjects with no history of syncope or presyncope. Circulation 92: 54–58

    Article  PubMed  CAS  Google Scholar 

  8. Kapoor WN, Brabt N (1992) Evaluation of syncope by upright tilt testing with isoproterenol. A nonspecific test. Ann Intern Med 116: 358–363

    Article  PubMed  CAS  Google Scholar 

  9. Raviele A, Menozi C, Brignole M et al (1995) Value of head-up tilt testing potentiated with sublingual nitroglycerin to assess the origin of unexplained syncope. Am J Cardiol 76: 267–272

    Article  PubMed  CAS  Google Scholar 

  10. Morillo CA, Klein GJ, Zandri S, Yea R (1995) Diagnostic accuracy of a low-dose isoproterenol head up tilt protocol. Am Heart J 129: 901–908

    Article  PubMed  CAS  Google Scholar 

  11. Kapoor WN, Smith M, Miller NL (1994) Upright tilt testing in evaluating syncope: a comprehensive literature review. Am J Med 97: 78–88

    Article  PubMed  CAS  Google Scholar 

  12. Benditt DG, Ferguson DW, Grubb BP et al (1996) Tilt table testing for assessing syncope. ACC expert consensus document. J Am Coll Cardiol 28: 263–275

    Article  PubMed  CAS  Google Scholar 

  13. Kapoor WN, Karpf M, Wieand S et al (1983) A prospective evaluation and follow-up of patients with syncope. N Eng J Med 309: 197–204

    Article  CAS  Google Scholar 

  14. Kapoor WN (1990) Evaluation and outcome of patients with syncope. Medicine 69: 160–175

    Article  PubMed  CAS  Google Scholar 

  15. Teichman SL, Felder SD, Matos JA, Kim SG, Waspe LE, Fisher JD (1985) The value of electrophysiologic studies in syncope of undetermined origin: report of 150 cases. Am Heart J 110: 469–479

    Article  PubMed  CAS  Google Scholar 

  16. Doherty JU, Pembrok-Rogers D, Grogan EW et al (1985) Electrophysiologic evaluation and follow-up characteristics of patients with recurrent unexplained syncope and presyncope. Am J Cardiol 55: 703–708

    Article  PubMed  CAS  Google Scholar 

  17. Fitzpatrick A, Theodorakis G, Vardas P, Sutton R (1991) Methodology of head-up tilt testing in patients with unexplained syncope. J Am Coll Cardiol 17: 125–130

    Article  PubMed  CAS  Google Scholar 

  18. Moya A, Romero B, Sagristâ J et al (1996) Sincope de origen desconocido: Rendimiento de un protocolo de estudio en seiscientos pacientes. Rev Esp Cardiol 49 [Suppl3]: 31 (abstr)

    Google Scholar 

  19. Rius T, Sagrista J, Mont L et al (1996) Utilidad clinica de la prueba en tabla basculante en pacientes con síncope y trastorno de la conducción intraventricular. Rev Esp Cardiol 49 [Suppl 3]: 33 (abstr)

    Google Scholar 

  20. Brignole M, Gianfranchi L, Menozzi C et al (1993) Role of autonomic reflexes in syncope associated with paroxysmal atrial fibrillation. J Am Coll Cardiol 22: 1123–1129

    Article  PubMed  CAS  Google Scholar 

  21. Leitch JW, Klein GJ, Yee R, Leather RA, Kim YH (1992) Syncope associated with supraventricular tachycardia. An expression of tachycardia rate or vasomotor response?. Circulation 85: 1064–1071

    Article  PubMed  CAS  Google Scholar 

  22. Alboni P, Menozzi C, Brignole M et al (1993) An abnormal neural reflex plays a role in causing syncope in sinus bradycardia. J Am Coll Cardiol 22: 1130–1134

    Article  PubMed  CAS  Google Scholar 

  23. Sutton R, Petersen M, Brignole M, Raviele A, Menozzi C, Giani P (1992) Proposed classification for tilt induced vasovagal syncope. Eur J Cardiac Pacing Electrophysiol 3: 180–183

    Google Scholar 

  24. Sagristâ J, Permanyer-Miralda G, Moya A, Romero B, Rius T, Soler Soler J (1996) Reproducibility of head-up tilt test in patients with recent syncope, normal ECG and no organic heart disease. PACE 19: 640 (abstr)

    Google Scholar 

  25. Sheldon R, Splawinski J, Killam S (1992) Reproducibility of upright tilt-table tests in patients with syncope. Am J Cardiol 69: 1300–1305

    Article  PubMed  CAS  Google Scholar 

  26. Harvey MN, Finta B, Goyal R et al (1996) Comparison of cardioinhibitory responses during tilt table testing and spontaneous episodes of syncope or near syncope. PACE 19: 616 (abstr)

    Google Scholar 

  27. Sra S, Murphy VS, Jayazeri MR et al (1992) Use of intravenous esmolol to predict efficacy of oral beta-adrenergic blocker therapy in patients with neurocardiogenic syncope. J Am Coll Cardiol 19: 402–408

    Article  PubMed  CAS  Google Scholar 

  28. Leor J, Rotstein Z, Vered Z, Kaplinsky E, Truman S, Eldar M (1994) Absence of tachycardia during tilt test predicts failure of beta-blocker therapy in patients with neurocardiogenic syncope. Am Heart J 127: 1539–1543

    Article  PubMed  CAS  Google Scholar 

  29. Benditt DG, Petersen M, Lurie K, Grubb BP, Sutton R (1995) Cardiac pacing for prevention of recurrent vasovagal syncope. Ann Int Med 122: 204–209

    Article  PubMed  CAS  Google Scholar 

  30. Sra JS, Jayazeri MR, Avitall B et al (1993) Comparison of cardiac pacing with drug therapy in the treatment of neurocardiogenic (vasovagal) syncope with bradycardia or asystole. N Eng J Med 328: 1085–1090

    Article  CAS  Google Scholar 

  31. R, Petersen MEV (1995) The clinical spectrum of neurocardiogenic syncope. J Cardiovasc Electrophysiol 6: 54–58

    Google Scholar 

  32. Sheldon R, Rose S, Flanagan P, Koshman ML, Killam S (1996) Risk factors for syncope recurrence after a positive tilt-table test in patients with syncope. Circulation 93: 973–981

    Article  PubMed  CAS  Google Scholar 

  33. Moya A, Romero B, Sagristâ J, Permanyer G, Rius T, Mont L, Soler-Soler J (1996) Relación de la respuesta a la prueba en tabla basculante con las características clínicas y evolutivas de los pacientes con sincope vasovagal. Rev Esp Cardiol 49 [Suppl 3]: 31 (abstr)

    Google Scholar 

  34. Morillo CA, Leitch JW, Yee R, Klein GJ (1993) A placebo controlled trial of intravenous and oral disopyramide for prevention of neurally mediated syncope. J Am Coll Cardiol 22: 1843–1848

    Article  PubMed  CAS  Google Scholar 

  35. Moya A, Permanyer-Miralda G, Sagristâ-Sauleda J et al (1995) Limitations of head-up tilt test for evaluating the efficacy of therapeutic interventions in patients with vaso-vagal syncope: results of a controlled study of etilefrine versus placebo. J Am Coll Cardiol 25: 65–69

    Article  PubMed  CAS  Google Scholar 

  36. Sutton R (1996) Is there an effective pharmacological treatment in the prevention of vasovagal syncope?. Arch Mal Coeur 89 (I): 25–28

    PubMed  Google Scholar 

  37. Brooks R, Ruskin JN, Powell AC, Newell J, Garan H, McGovern BA (1993) Prospective evaluation of day-to-day reproducibility of upright tilt-table testing in unexplained syncope. Am J Cardiol 71: 1289–1292

    Article  PubMed  CAS  Google Scholar 

  38. Chen XC, Chen MY, Remole S et al (1993) Reproducibility of head up tilt-table testing for eliciting susceptibility to neurally mediated syncope in patients without structural heart disease. Am J Cardiol 71: 1289–1292

    Article  Google Scholar 

  39. Raviele A, Gasparini G, DiPede F, Delise P, Bonso A, Picolo E (1990) Usefulness of head-up tilt test in evaluating patients with syncope of unknown origin and negative electrophysiologic study. Am J Cardiol 65: 1322–1327

    Article  PubMed  CAS  Google Scholar 

  40. Milsetin S, Buetikofer J, Dunningan A, Benditt DG, Gornik C, Reyes WJ (1990) Usefulness of disopyramide for prevention of upright tilt-induced hypotension and bradycardia. Am J Cardiol 65: 1330–1344

    Google Scholar 

  41. Muller G, Deal BD, Strasburger JF, Benson DW (1993) Usefulness of metoprolol for unexplained syncope and positive responses to tilt testing in young persons. Am J Cardiol 71: 592–595

    Article  PubMed  CAS  Google Scholar 

  42. Grubb BP, Wolfe DA, Samoil D, Temesy-Armos P, Hahn H, Elliot L (1993) Usefulness of fluoxetine hydrocloride for prevention of resistant upright tilt induced syncope. PACE 16: 458–464

    Article  PubMed  CAS  Google Scholar 

  43. Grubb BP, Samoil D, Kosinski D, Kip K, Brewster P (1994) Use of sertraline hydro-d oride in the treatment of refractory neurocardiogenic syncope in children and adolescents. J Am Coll Cardiol 24: 490–494

    Article  PubMed  CAS  Google Scholar 

  44. Brignole M, Menozzi C, Gianfranchi L, Lolli G, Bottoni N, Oddone D (1992) A controlled trial of acute and long-term medical therapy for vasodepressor vasovagal syncope. Am J Cardiol 70: 339–342

    Article  PubMed  CAS  Google Scholar 

  45. Dhala A, Natale A, Sra J et al (1995) Relevance of asystole during head-up tilt testing. Am J Cardiol 75: 251–254

    Article  PubMed  CAS  Google Scholar 

  46. Mahanonda N, Bhuripanyo K, Kangkagate C et al (1995) Randomized double-blind, placebo-controlled trial of oral atenolol in patients with unexplained syncope and positive upright tilt table test results. Am Heart J 130: 1250–1253

    Article  PubMed  CAS  Google Scholar 

  47. Jhamb DK, Singh B, Sharda B et al (1996) Comparative study of the efficacy of metoprolol and verapamil in patients with syncope and positive head-up tilt response. Am Heart J 132: 608–611

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Unitat d’Arítmies, Servei de Cardiologia, Hospital Vall d’Hebron, Barcelona, Spain

    A. Moya, T. Rius, J. Sagristá & G. Permanyer-Miralda

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  1. A. Moya
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  2. T. Rius
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  3. J. Sagristá
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  4. G. Permanyer-Miralda
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Editors and Affiliations

  1. Divisione di Cardiologia, Ospedale Umberto I, Via Circonvallazione 50, I-30174, Venezia Mestre, Italy

    Antonio Raviele MD

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© 1998 Springer-Verlag Italia

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Moya, A., Rius, T., Sagristá, J., Permanyer-Miralda, G. (1998). Is Tilt Testing Really Useful for Selecting Vasovagal Therapy?. In: Raviele, A. (eds) Cardiac Arrhythmias 1997. Springer, Milano. https://doi.org/10.1007/978-88-470-2288-1_53

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  • DOI: https://doi.org/10.1007/978-88-470-2288-1_53

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2290-4

  • Online ISBN: 978-88-470-2288-1

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