Europace Advance Access originally published online on November 5, 2008
Europace 2009 11(2):225-230; doi:10.1093/europace/eun299
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Syncope
Electrocardiographic characteristics of atrioventricular block induced by tilt testing
ko1,*
luk31 Teaching Department for Emergency Medical Service, Wroclaw Medical University, Bartla Street 5, 51-618 Wroclaw, Poland; 2 Department of Cardiology, Wroclaw Medical University, Poland; 3 First Department of Cardiology, Warsaw Medical University, Poland
Aims: The electrocardiographic (ECG) characteristics of atrioventricular (AV) block during reflex syncope may be unique due to the presence of hypervagotonia. The aim of the present study was to define the ECG characteristics of the AV block induced by neurocardiogenic reflex provoked by tilt testing (TT).
Methods and results: A series of 31 patients with presumed vasovagal syncope and AV block provoked by TT was studied. The duration of PP and PR interval, AV block grade and type, concomitant arrhythmias, and timing of the AV block occurrence were assessed. The AV block occurred at TT termination in 26 patients, in the recovery in 4 patients, and in both periods in 1 patient. Atrioventricular block was preceded by sinus slowing, and sinus rhythm during AV block was slow and instable. Mobitz I, 2:1 second-degree AV block, and advanced second-degree AV block were recognized in 35.5, 48.4, and 67.8% of patients, respectively. Third-degree AV block was diagnosed in 41.9% of patients. Twenty-one patients had at least two AV block forms. The most prevalent concomitant arrhythmia was junctional escape rhythm (61.3%).
Conclusion: (i) The occurrence of the AV block during neurocardiogenic reaction induced by TT is always preceded by sinus rhythm slowing and usually by PR interval prolongation. (ii) The AV block provoked by TT usually occurs at TT termination, but may occur even in the recovery period in a supine position. Sometimes the AV block may be present both at TT termination and during the recovery period.
Key Words: Tilt testing, Vasovagal syncope, Atrioventricular block
* Corresponding author. Tel: +48 717842611, Fax: +48 713270961, E-mail: dzysko{at}wp.pl
Manuscript submitted 27 July 2008. Accepted after revision 13 October 2008.
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  M. Brignole Different electrocardiographic manifestations of the cardioinhibitory vasovagal reflex Europace, February 1, 2009; 11(2): 144 - 146. [Full Text] [PDF]
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