Risk Factors for Syncope Recurrence After a Positive Tilt-Table Test in Patients With Syncope

OBJECTIVETo evaluate the outcome of patients with NCS after interruption of pharmacological therapy and to investigate the possible clinical variables predicting recurrence. METHODSThirty-seven patients (age 31±16 years) with refractory recurrent NCS being 19 females where prospectively studied. All patients became asymptomatic and had a negative tilt table test (TT) after pharmacological therapy. The treatment was interrupted and one month later, a new TT with no medication was carried out. The probability free of symptoms recurrence was analyzed according to sex, age, number of syncope episodes previously to the treatment, clinical history time, treatment time, drug free from treatment time and TT result. RESULTSTwenty-two patients (59%) presented recurrence during a mean follow-up of 21±19.7 months. The variables related to greater recurrence were number of previous syncope (p=0.0248), positive TT after interruption of the therapy (p=0.0002) and female gender (p= 0.0131). CONCLUSIONSMost of the very symptomatic patients with NCS present recurrence after the suppression of a specifi c therapy. A TT carried out after treatment discontinuation can identify patients with higher risk of recurrence, specially in the fi rst year of follow-up.

Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Evolução clínica de pacientes com síncope neurocardiogênica (SNC) após suspensão da terapia específica

Bastos¹,

Scanavacca

Darrieux

et al. 2006

“…The tilt table test -the method used to confirm vasovagal syncope diagnosis -is quite specific, although its positivity index does not exceed 60%, according to literature [11][12][13] . Some patients who have persisted in their unexplained syncope condition may have had the vasovagal etiology as well, although TTT low sensitivity has not allowed their identification.…”

Section: Resultsmentioning

confidence: 99%

Síncope em pacientes com extra-sístoles de via de saída de ventrículo direito e sem cardiopatia estrutural aparente

Ludovice¹,

Hachul²,

Darrieux³

et al. 2006

objective: Study the prevalence of neurocardiogenic etiology in patients with unexplained syncope and ventricular premature beats, with right ventricle outflow tract morphology (RVOT) and no apparent structural cardiopathy. Methods:Ninety patients (66 women, mean age 40.2±16.95 years of age) with monomorphic premature beats originated at RVOT were evaluated prospectively. Fifty-four (54) patients reported syncopes or near-syncopes associated to palpitations or not; twenty-seven (27) presented palpitations with no pre-syncope or syncope, and nine (9) were asymptomatic. All patients were submitted to echocardiogram, high resolution ECG and cardiac MRI to rule out structural cardiopathy, to exertion test to rule out adrenergic dependent ventricular tachycardia, and ECG prolonged outpatient monitoring (Holter and symptomatic events monitor) to correlate symptoms and ventricular arrhythmias. Investigation on the susceptibility to neurocardiogenic syncope was evaluated by Tilt Table Test (TTT). Groups were compared regarding gender, age, premature beats frequency and complexity, at exertion or not, TTT results and clinical course. Results:In the syncope and pre-syncope groups, TTT was positive for 38% of cases, and in groups with palpitations and assymptomatics, it was positive for 11% (p = 0.0257). After recommendations and treatment of neurocardiogenic syncope, 85% of syncope and pre-syncope patients and positive TTT was asymptomatic along the 40-month follow-up. Two patients with syncope and negative TTT presented spontaneous, sustained ventricular tachycardia during clinic course. Conclusion:The prevalence of neurocardiogenic syncope in patients with idiopathic RVOT premature beats is high. Patients with recurrent, unexplained syncope and idiopathic VE must be kept under investigation. VPBs with right ventricle outflow tract morphology (RVOT) at ECG are frequently seen. Those patients may present recurring near-syncopes and syncopes, and most times it is not possible to establish a correlation between rhythm changes and the symptoms during outpatient ECG monitoring.Recurrent syncope is an alarming symptom. Syncope etiology is many times erroneously associated to that arrhythmia in individuals irrespective of the clinical correlation between symptoms and electrocardiographic findings.The neurocardiogenic syncope is the most common syncope etiology in individuals without apparent cardiopathy. It has not been reported a higher cardiovascular risk in that group of patients when compared to the normal population 3,4 . Diagnosis is reached by suggestive history, by the nondemonstration of arrhythmic causes and by positive TTT.The purpose of this study was to investigate the prevalence of neurocardiogenic syncope in patients with idiopathic RVOT premature beats. MethodsNinety patients were investigated prospectively: mean age 40.2 ± 16.95 (ranging between 7 and 79 years of age), being 66 of them females. Inclusion criteria included: the presence of idiopathic RVOT premature beats, characterized by left bundle branch bloc...

“…Sheldon et al 28 questioned the value of a positive UTT for predicting syncope and near-syncope. They showed that a decrease in syncope recurrence is expected after a positive UTT (from 0.3 to 0.03 episodes a month) in the absence of medication.…”

Section: Discussionmentioning

confidence: 99%

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

Hachul¹,

Scanavacca²,

Sosa³

2002

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.