Does a Role Exist for Tilting-Guided Therapy in the Management of Neurocardiogenic Syncope?

Abstract

Purpose -Upright tilt-table testing (UTT) is an useful method for identifying patients with neurocardiogenic syncope, but its role in the evaluation of therapeutic efficacy is controversial. The aim of this study was to determine the correlation between negative UTT after therapy introduction (acute efficacy) and symptom recurrence during follow-up (chronic efficacy). Methods -We studied 56 severely symptomatic patients (age 27±19 years) with recurrent (7±12 episodes) neurocardiogenic syncope (positive UTT). Once empirical pharmacological therapy was initiated, all patients underwent another UTT (therapeutic evaluation test -TET). Therapy was not modified after TET results. The probability of symptom recurrence was analyzed with the Kaplan-Meier method and compared by log-rank test in patients with negative and positive TET.Results -Negative UTT after therapy was related to a significantly lower probability of recurrence during follow-up (4.9 versus 52.4% in 12 months, P<0.0001). Conclusion -A good correlation exists between acuteand long-term efficacy of pharmacological therapy for neurocardiogenic syncope, so that serial UTT may be considered a good method for identifying an effective therapeutic strategy.

Teste de inclinação (Tilt-test): do necessário ao imprescindível

“…Hachul et al 39 reported that, after the institution of the treatment for Vasovagal Syndrome, the HUTT with negative result was associated with the lower recurrence of symptoms in relation to the positive result (4.9 versus 52.4%, in 12 months, p<0.0001). Bastos et al 40 analyzed the capacity of the test to predict the recurrence of symptoms after discontinuation of medication and they found that 84% of patients with positive HUTT, under this condition, developed the symptoms again after being monitored for 12 months.…”

Síndromes neuralmente mediadas

“…As it has already been mentioned, some individuals might present symptoms of orthostatic intolerance, with changes in their brain blood perfusion which is not gauged in the regular protocol of this test whereas some others have the symptoms only due to their psychosomatic condition. The standard response during the tilt test can provide significant information for the management of these patients 32 .…”

“…The risks involved for undergoing the test is extremely low. The use of the tilt table test to evaluate the therapeutic efficacy has been controversial as observed in different series 31,32 . Several other methods have been described and are being evaluated, such as the use of sensitization agents in the first phase or shorter tests (twenty minutes) followed by pharmacological sensitization 28,33 .…”

Predição de duração de tratamento e recorrência em pacientes portadores de síncope vasovagal: há luz no fim do túnel?

“…The reasons being primarily the poor reproducibility of tilt testing in the long-term and the marked placebo or therapeutic effect that tilt table test has by its own. Hachul et al have previously reported a lower recurrence of syncope in treated patients with a follow-up negative tilt test compared to those that remain with inducible VVS during tilt 5 . These observations are provocative but are limited by the fact that this data was not derived from a randomized study.…”