© 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.
SYNCOPE
Repeated tilt testing in patients with tilt-positive neurally mediated syncope
aDepartment of Cardiology, University Hospital Gasthuisberg Leuven, Belgium; bDepartment of Cardiovascular Rehabilitation, University Hospital Gasthuisberg Leuven, Belgium; cDepartment of Rehabilitation Sciences, University of Leuven Leuven, Belgium
Abstract
In this study we have included 222 patients with apparent neurally mediated syncope and with a positive diagnostic tilt test. The mean age was 33.4 ± 21.2 years (median 25.3): there were 107 men (median age 25.3) and 115 women (median age 22.6). The age difference between males and females was statistically significant (P = 0.002).
The response to the diagnostic tilt test was: type 1 (mixed) in 74 patients; type 2A (cardioinhibitory and bradycardia) in 6; type 2B (cardioinhibitory and asystole) in 61; type 3 (vasodepressor) in 81.
In all 222 patients the diagnostic tilt test was positive after 19 ± 11 min (mean ± SD), median time: 18 min. For the four types of syncope, the duration in minutes of the diagnostic tilt test was: type 1 (mixed) 19.5 ± 11.4; type 2A (cardioinhibitory) 24.8 ± 13.6; type 2B (cardioinhibitory and asystole) 14.7 ± 10.2; type 3 (vasodepressor) 21.6 ± 11.1. A significant difference was found between type 2B and type 3 responses (P = 0.002). Between males and females no significant differences in the duration of the diagnostic tilt test were found, neither for all responses, nor for the four subtypes.
A type 2B (cardioinhibitory and asystole) response occurred in 61 patients. The duration of asystole was 12.8 ± 10.6 s (mean ± SD; median 9, minimum 3, maximum 60).
The head-up tilt test was repeated day after day: one session per day. The response became negative at the second session in 119 patients (54%); at session 3 in 47 (21%); at session 4 in 30 (13%); at session 5 in 15 (7%); at session 6 in 6 (3%); at session 7 in 2 (1%); at session 8 in 3 (1%). For all 222 patients the mean number of sessions in order to obtain a negative tilt test was 2.9 (SD 1.3; median 2).
Only 25% of patients remained tilt-positive for three or more sessions. A negative tilt test was ultimately obtained in every patient.
Follow-up data are available for 202/222 patients. The time span between the first and last tilt test was 11.1 ± 10 months (median 8.8). Of these 202 patients, 163 remained free of any event (80.7%).
Key Words: syncope, tilt test, orthostatic intolerance, tilt training
*Corresponding author. Department of Cardiology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium. Tel.: +32 16 344 248; fax: +32 16 344240. E-mail address: hugo.ector{at}med.kuleuven.ac.be
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  B. Verheyden, H. Ector, A. E. Aubert, and T. Reybrouck Tilt training increases the vasoconstrictor reserve in patients with neurally mediated syncope evoked by head-up tilt testing Eur. Heart J., June 2, 2008; 29(12): 1523 - 1530. [Abstract] [Full Text] [PDF]
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