Prognostic Value of a Very Prolonged Asystole during Head-Up Tilt Test.

Abstract

BACKGROUND:

Clinical significance and prognosis of a cardioinhibitory response to head-up tilt (HUT) test with a very prolonged asystole (≥30 seconds) is poorly studied. Our aim was to evaluate the treatment (including pacemaker implantation) and prognosis (syncope recurrence, syncope-related trauma, and overall mortality) of patients with a very prolonged asystole on a HUT test.

METHODS AND RESULTS:

A retrospective study was conducted in two centers between January 2003 and December 2013 and included a total of 2,263 consecutive HUT tests (sensitized with isosorbide dinitrate) performed in 2,247 patients with syncope of unknown etiology. Cardioinhibitory response with asystole was observed in 149 (6.6%) of these tests (44.3% women, mean age 37 ± 18 years old, 16.1% in the nonpharmacological phase), with a median duration of asystole of 10 (6-19) seconds. Very prolonged asystole (≥30 seconds) was documented in 11 (0.5%) patients (45% women; mean age 40 ± 19 years; only one in the nonpharmacological phase, 9 minutes after HUT). The longest pause lasted 63 seconds. In all patients, avoidance of triggering factors and physical counterpressure maneuvers were recommended. Telephone follow-up was performed: in one patient, fludrocortisone was started; tilt training was conducted in one patient and none received a pacemaker. After a median follow-up of 42 (30-76) months, four patients (36%) had syncopal recurrences, one patient had a syncope-related injury (scalp laceration), and no patient died.

• Authors: Maria Salomé Carvalho, Katya Reis Santos, Pedro Carmo, Diogo Cavaco, Leonor Parreira, Francisco Morgado, Pedro Adragão
• Journal: Pacing and clinical electrophysiology : PACE (Pacing Clin Electrophysiol) Vol. 38 Issue 8 Pg. 973-9 (Aug 2015) ISSN: 1540-8159 [Electronic] United States
• PMID: 25940375 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2015 Wiley Periodicals, Inc.

Topics

• Adult
• Aged
• Female
• Heart Arrest (mortality)
• Humans
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Syncope (diagnosis, mortality)
• Tilt-Table Test
• Young Adult