Value of head-up tilt testing potentiated with sublingual nitroglycerin to assess the origin of unexplained syncope

Raviele, Antonio; Menozzi, Carlo; Brignole, Michele; Gasparini, G.; Alboni, Paoló; Musso, Giacomo; Lolli, Gino; Oddone, Daniele; Dinelli, Maurizio; Mureddu, Roberto

doi:10.1016/s0002-9149(99)80079-4

Cited by 219 publications

(114 citation statements)

References 27 publications

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“…In the analysis of five studies that evaluated the result of exposure to passive orthostasis, lasting at least 40 minutes, the sensitivity rates noted were 13%, 25%, 31%, 35% and 75% (median of 31%) [9][10][11][12] . In contrast to the low sensitivity, the specificity was 100%, 100%, 95%, 92% and 89%, respectively (mean of 95%).…”

Section: Protocolsmentioning

confidence: 99%

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

Macedo

Leite²,

Santos-Neto

et al. 2011

Arq. Bras. Cardiol.

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Section: Protocolsmentioning

confidence: 99%

“…In a subsequent study, the same researchers evaluated the effect of sublingual nitroglycerin 10 . Initially, patients lay on a table that was tilted up to an angle of 60° for 45 minutes (passive tilt), which resulted in low sensitivity (25%) and high specificity (100%).…”

Section: Protocolsmentioning

confidence: 99%

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

Macedo

Leite²,

Santos-Neto

et al. 2011

Arq. Bras. Cardiol.

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“…It was highly recommended that we use noninvasive continuous monitoring of arterial pressure; a sphygmomanometer cuff was permitted, rendering subclassification into VASIS 2A and 2B categories difficult. Beginning in November 1996, sublingual nitroglycerin provocation 14 was added. If syncope did not develop during the initial passive phase, 300 g nitroglycerin was administered sublingually, and patients continued to be tilted for an additional 20 minutes.…”

Section: Tilt Test Protocolmentioning

confidence: 99%

Dual-Chamber Pacing in the Treatment of Neurally Mediated Tilt-Positive Cardioinhibitory Syncope

et al. 2000

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Background-This study was performed to compare implantation of a DDI pacemaker with rate hysteresis with no implant in respect to syncopal recurrences in patients with severe cardioinhibitory tilt-positive neurally mediated syncope. Methods and Results-Forty-two patients from 18 European centers were randomized to receive a DDI pacemaker programmed to 80 bpm with hysteresis of 45 bpm (19 patients) or no pacemaker (23 patients). Inclusion criteria were Ն3 syncopes over the last 2 years and a positive cardioinhibitory (Vasovagal Syncope International Study types 2A and 2B) response to tilt testing. The median number of previous syncopal episodes was 6; asystolic response to tilt testing was present in 36 patients (86%) (mean asystole, 13.9Ϯ10.2 seconds). All patients were followed up for a minimum of 1.0 years and a maximum of 6.7 years (mean, 3.7Ϯ2.2). One patient (5%) in the pacemaker arm experienced recurrence of syncope compared with 14 patients (61%) in the no-pacemaker arm (Pϭ0.0006). In the no-pacemaker arm, the median time to first syncopal recurrence was 5 months, with a rate of 0.44 per year. On repeated tilt testing performed within 15 days after enrollment, positive responses were observed in 59% of patients with pacemakers and in 61% of patients without pacemakers (PϭNS). Conclusions-In a limited, select group of patients with tilt-positive cardioinhibitory syncope, DDI pacing with hysteresis reduced the likelihood of syncope. The benefit of the therapy was maintained over the long term. Even in untreated patients, the syncopal recurrence burden was low. A negative result of tilt testing was not a useful means to evaluate therapy efficacy. (Circulation. 2000;102:294-299.)

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“…Patients underwent TTT according to the University of Wisconsin protocol, a modification of the Italian protocol [32]. Briefly, after allowing the patient to rest in the supine position for 10 minutes, the table was tilted to 70°.…”

Section: Tilt Table Testmentioning

confidence: 99%

“…While the underlying mechanisms remain poorly defined, the baroreflex has long been implicated in its pathogenesis with tilt table testing (TTT) remaining the diagnostic test of choice in patients with suspected VVS [22]. The incidence of positive TTT depends on the clinical presentation with a higher positivity rate noted in patients with typical symptoms when compared to patients with atypical symptoms or unexplained syncope [12,15,31,32].…”

Section: Introductionmentioning

confidence: 99%

The pathophysiologic mechanisms associated with hypotensive susceptibility

et al. 2016

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Introduction Patients with vasovagal syncope (VVS) and positive tilt table test (TTT) were not found to benefit from pacing in the ISSUE-3 trial despite the presence of spontaneous asystole during monitoring. "Hypotensive susceptibility" unmasked by TTT was reported as a possible explanation. The purpose of this study was to assess the pathophysiologic mechanisms associated with hypotensive susceptibility.

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Value of head-up tilt testing potentiated with sublingual nitroglycerin to assess the origin of unexplained syncope

Cited by 219 publications

References 27 publications

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

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

Dual-Chamber Pacing in the Treatment of Neurally Mediated Tilt-Positive Cardioinhibitory Syncope

The pathophysiologic mechanisms associated with hypotensive susceptibility

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