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Europace 1999 1(1):63-68; doi:10.1053/eupc.1998.0015
© 1999 by European Society of Cardiology
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Clinical usefulness of head-up tilt test in patients with syncope and intraventricular conduction defect

J. Sagristà-Sauleda, B. Romero, G. Permanyer-Miralda, A. Moya, T. Rius-Gelabert, L. Mont Girbau and J. Soler-Soler

Servei de Cardiologia, Hospital General Universitari Vall d’Hebron Barcelona, Spain

Head-up tilt test was performed in 99 patients with syncope of unknown origin and intraventricular conduction defect. Twenty-five per cent had a positive response to tilt with reproduction of spontaneous clinical symptoms. Holter recording revealed paroxysmal atrioventricular (AV) block in three patients. Carotid sinus massage was positive in four patients. An electrophysiological study was performed in 76 patients with abnormal findings in 17 (22%). Thus, vasovagal syncope was the discharge diagnosis in 25 patients (25%). Therefore, tilt test should be considered in patients with intraventricular conduction defect presenting with syncope of unknown origin, especially if clinical findings suggest the possibility of a vasovagal mechanism, or if the results of the electrophysiological study are inconclusive.

Key Words: Syncope, tilt test, intraventricular conduction defects


Correspondence: J. Sagristà-Sauleda, Servei de Cardiologia, Hospital General Universitari Vall d’Hebron, Paseo Vall d’Hebron 119–129, Barcelona, 08035 Spain.


[1] Kenny RA, Ingram A, Bayliss J, et al. Head-up tilt: a useful test for investigating unexplained syncope. Lancet 1986; 1: 1352–1355.[CrossRef][Web of Science][Medline]

[2] Abi-Samra F, Maloney JD, Fouad-Tarazi FR, et al. The usefulness of head-up tilt testing and hemodynamic investigations in the workup of syncope of unknown origin. PACE 1988; 11: 1202–1204.

[3] Strasberg B, Rechavia E, Sagie A, et al. The head-up tilt table test in patients with syncope of unknown origin. Am Heart J 1989; 118: 923–7.[CrossRef][Web of Science][Medline]

[4] Almquist A, Goldenberg IF, Milstein S, et al. Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope. N Engl J Med 1989; 320: 346–51.[Abstract]

[5] Waxman MB, Yao L, Cameron DA, et al. Isoproterenol induction of vasodepressor-type reaction in vasodepressorprone persons. Am J Cardiol 1989; 63: 58–65.[CrossRef][Web of Science][Medline]

[6] Pongiglione G, Fish FA, Strasburger JF, et al. Heart rate and blood pressure response to upright tilt in young patients with unexplained syncope. J Am Coll Cardiol 1990; 16: 165–70.[Abstract]

[7] Raviele A, Gasparini G, Di Pede F, et al. Usefulness of head-up tilt test in evaluating patients with syncope of unknown origin and negative electrophysiologic study. Am J Cardiol 1990; 65: 1322–7.[CrossRef][Web of Science][Medline]

[8] Fitzpatrick AP, Theodorakis G, Vardas P, et al. Methodology of head-up tilt testing in patients with unexplained syncope. J Am Coll Cardiol 1991; 17: 125–30.[Abstract]

[9] Sra JS, Anderson AJ, Sheikh SH, et al. Unexplained syncope evaluated by electrophysiologic studies and head-up tilt testing. Ann Intern Med 1991; 114: 1013–9.[Web of Science][Medline]

[10] Grubb BP, Temesy-Armos P, Moore J, et al. Head-upright tilt-table testing in evaluation and management of the malignant vasovagal syndrome. Am J Cardiol 1992; 69: 904–8.[CrossRef][Web of Science][Medline]

[11] Sheldon R and Killam S. Methodology of isoproterenol-tilt table testing in patients with syncope. J Am Coll Cardiol 1992; 19: 773–9.[Abstract]

[12] Moya A, Permanyer Miralda G, Sagristà Sauleda J, et al. Análisis de las respuestas a la prueba en tabla basculante en función de las caracteristicas clinicas de los episodios sincopales en pacientes sin cardiopatia aparente. Rev Esp Cardiol 1993; 46: 214–9.[Medline]

[13] Kapoor WN, Smith MA, Miller NL. Upright tilt testing in evaluating syncope a comprehensive literature review. Am J Med 1994; 97: 78–80.[CrossRef][Web of Science][Medline]

[14] Kapoor WN, Karpf M, Wieland S, et al. A prospective evaluation and follow-up of patients with syncope. N Engl J Med 1983; 309: 197–204.[Abstract]

[15] Dhingra RC, Denes P, Wu P, et al. Syncope in patients with chronic bifascicular block. Significance, causative mechanisms, and clinical implications. Ann Intern Med 1974; 81: 302–6.[CrossRef][Web of Science][Medline]

[16] McAnulty JH, Rahimtoola SH, Murphy E, et al. Natural history of "high-risk" bundle-branch block. Final report of a prospectic study. N Engl J Med 1982; 307: 137–43.[Abstract]

[17] Peters RW, Scheinman MM, Modin G, et al. Prophylactic permanent pacemakers for patients with chronic bundle branch block. Am J Med 1979; 66: 978–85.[CrossRef][Web of Science][Medline]

[18] Scheinman MM, Peters RW, Sauve MJ, et al. Value of the H-V interval in patients with bundle branch block and the role of prophylactic permanent pacing. Am J Cardiol 1982; 50: 1316–22.[CrossRef][Web of Science][Medline]

[19] Raviele A, Proclemer A, Gasparini J, et al. Long-term follow-up of patients with unexplained syncope and negative electrophysiologic study. Eur Heart J 1989; 10: 127–32.[Abstract/Free Full Text]

[20] Muller T, Roy D, Talajic M, et al. Electrophysiologic evaluation and outcome of patients with syncope of unknown origin. Eur Heart J 1991; 12: 139–43.[Abstract/Free Full Text]

[21] Moya A, Permanyer-Miralda G, Sagristà-Sauleda J, et al. Limitations of head-up tilt test for evaluating the efficacy of therapeutic interventions in patients with vasovagal syncope Results of a controlled study of etilefrine versus placebo. J Am Coll Cardiol 1995; 25: 65–9.[Abstract]

[22] Englund A, Fredrikson M, Rosenqvist M. Head-up tilt test. A nonspecific method of evaluating patients with bifascicular block. Circulation 1997; 95: 951–4.[Abstract/Free Full Text]

[23] Fujimura O, Yee R, Klein GJ, et al. The diagnostic sensitivity of electrophysiologic testing in patients with syncope caused by transient bradycardia. N Engl J Med 1989; 321: 1703–7.[Abstract]

[24] Krahn AD, Klein JG, Norris C, et al. The etiology of syncope in patients with negative tilt table and electrophysiologic testing. Circulation 1995; 92: 1819–24.[Abstract/Free Full Text]

[25] Dhingra RC, Palileo E, Strasberg B, et al. Significance of the HV interval in 517 patients with chronic bifascicular block. Circulation 1981; 64: 1265–71.[Abstract/Free Full Text]

[26] Grimm W, Degenhardt M, Hoffman J, Menz V, Wirths A, Maisch B. Syncope recurrence can better be predicted by history than by head-up tilt testing in untreated patients with suspected neurally mediated syncope. Eur Heart J 1997; 18: 1465–9.[Abstract/Free Full Text]

[27] Leitch JM, Klein GJ, Yee R, et al. Syncope associated with supraventricular tachycardia. An expresion of tachycardia rate or vasomotor response? Circulation 1992; 85: 1064–71.[Abstract/Free Full Text]

[28] Brignole M, Gianfranchi L, Menozzi C, et al. Role of autonomic reflexes in syncope associated with paroxysmal atrial fibrillation. J Am Coll Cardiol 1993; 22: 1123–9.[Abstract]

[29] Gaggioli G, Brignole M, Menozzi C, et al. A positive response to head-up tilt testing predicts syncopal recurrence in carotid sinus syndrome patients with permanent pacemakers. Am J Cardiol 1995; 76: 720–2.[CrossRef][Web of Science][Medline]


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