Prevalence of asystole during tilt test-induced vasovagal syncope may depend on test methodology
OA Location
Author(s)
Type
Journal Article
Abstract
This review addresses tilt-testing methodology by searching the literature which reports timing of asystole and loss of consciousness (LOC). Despite the Italian protocol being the most widely adopted, its stipulations are not always followed to the letter of the European Society of Cardiology guidelines. The discrepancies permit reassessment of the incidence of asystole when tilt-down is early, impending syncope, compared with late, established LOC. Asystole is uncommon with early tilt down and diminishes with increasing age. However, if LOC is established as test-end, asystole is more common, and it is age-independent. Thus, the implications are that asystole is commonly under-diagnosed by early tilt-down. The prevalence of asystolic responses observed using the Italian protocol with a rigorous tilt down time is numerically close to that observed during spontaneous attacks by electrocardiogram loop recorder. Recently, tilt-testing has been questioned as to its validity but, in selection of pacemaker therapy in older highly symptomatic vasovagal syncope patients, the occurrence of asystole has been shown to be an effective guide for treatment. The use of head-up tilt test as an indication for cardiac pacing therapy requires pursuing the test until complete LOC. This review offers explanations for the findings and their applicability to practice. A novel interpretation is offered to explain why pacing induced earlier may combat vasodepression by raising the heart rate when sufficient blood remains in the heart.
Date Issued
2023-02-01
Date Acceptance
2022-08-23
Citation
Europace, 2023, 25 (2), pp.263-269
ISSN
1099-5129
Publisher
Oxford University Press
Start Page
263
End Page
269
Journal / Book Title
Europace
Volume
25
Issue
2
Copyright Statement
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000849782400001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=a2bf6146997ec60c407a63945d4e92bb
Subjects
AGE
Asystole
Cardiac & Cardiovascular Systems
Cardiac pacing
Cardioinhibition
Cardiovascular System & Cardiology
Head-up tilt testing
Life Sciences & Biomedicine
NEURALLY-MEDIATED SYNCOPE
RESPONSES
Science & Technology
SOCIETY
SUBLINGUAL NITROGLYCERIN
Syncope
THERAPY
Vasodepression
Publication Status
Published
Date Publish Online
2022-09-05