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Europace Advance Access originally published online on March 4, 2009
Europace 2009 11(5):635-637; doi:10.1093/europace/eup044
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Syncope

What is the optimal duration of tilt testing for the assessment of patients with suspected postural tachycardia syndrome?

Sheila Carew*, John Cooke, Margaret O'Connor, Teresa Donnelly, Aine Costelloe, Christine Sheehy and Declan Lyons

Clinical Age Assessment Unit, Mid-Western Regional Hospital, Dooradoyle, Limerick, Ireland

Aims: The aim of this study is to define the optimal duration of tilt testing for the assessment of patients with suspected postural tachycardia syndrome (POTS).

Methods and results: This was a case–control study. Cases were identified retrospectively from a database of patients referred with orthostatic intolerance (OI). All met the diagnostic criteria for POTS. Controls were enrolled prospectively. All subjects underwent tilting to 70° for 40 min if tolerated. Continuous monitoring was provided by a Finometer. Analysis of responses to tilting was performed on 28 cases and 28 controls. The mean age in the case group was 23.6 and in the control group was 26.2. The majority was female in both groups (cases = 4F:3M, controls = 2F:1M). All cases met the criteria for POTS within 7 min of orthostasis. No controls demonstrated a sustained tachycardia. The prevalence of vasovagal syncope (VVS) was 36% in cases vs. 7% in controls (P = 0.02) and 25% in the remaining patients (n = 233) on the OI database (P = 0.259).

Conclusion: A 10 min tilt will diagnose POTS in the majority of patients. It will not, however, be sufficient to identify the overlap that exists between POTS and VVS. The optimal duration of tilt testing in patients suspected of POTS is 40 min.

Key Words: Postural orthostatic tachycardia syndrome, Tilt testing, Syncope, Orthostatic intolerance, Vasovagal syncope

* Corresponding author. Tel: +353 61 482623, Fax: +353 61 482509, Email: sheila.carew{at}hse.ie

Manuscript submitted 16 October 2008. Accepted after revision 28 January 2009.


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