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Asystolic Cardiac Arrest During Head‐Up Tilt Test: Incidence and Therapeutic Implications
Author(s) -
LACROIX DOMINIQUE,
KOUAKAM CLAUDE,
KLUG DIDIER,
GUÉDONMOREAU LAURENCE,
VAKSMANN GUY,
KACET SALEM,
LEKIEFFRE JEAN
Publication year - 1997
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1997.tb05432.x
Subject(s) - medicine , asystole , presyncope , cardiopulmonary resuscitation , syncope (phonology) , anesthesia , cardiology , vasovagal syncope , bradycardia , implantable loop recorder , resuscitation , heart rate , atrial fibrillation , blood pressure
Occasionally, the cardioinhibitory response may be profond during tilt induced syncope. Whether this response is associated with more severe symptoms or predicts a poor response to pharmacotherapy remains controversial. The aim of this study was to characterize patients with vasovagally mediated asystole occurring during head‐up tilt test and to evaluate the respective interests of sequential pacing and β‐blockers to treat them. We performed 60° tilt testing in 179 consecutive patients with unexplained syncope (91 women and 88 men, age 36.6 ± 20.1 years). Asystole was defined as a ventricular pause > 5 seconds. All patients with tilt induced asystole received therapy with either β‐blockers or sequential pacing, the efficacy of which was evaluated with serial tilt tests. Of 77 patients with positive tilt test, 10 developed syncope related to asystole (mean duration 11.9 ± 4.9 s), 2 with spontaneous recovery, and 8 with seizures needing a brief cardiopulmonary resuscitation. When compared with patients without asystole, asystolic patients had more severe symptoms (seizures: 6/10 vs 9/67, P = 0.05, injury: 9/10 vs 27/67, P = 0.0048). In the first six patients in whom cardiac pacing was considered, syncope or presyncope still occurred despite atrioventricular pacing at 45 beats/min. Five of these 6 patients, as well as the remaining 4 asystolic patients, were tilted with β‐biockers: 3 patients became tilt‐negative; 3 were significantly improved; and 3 did not respond. During follow‐up (mean 22.7 ± 11.7 months) with every patient taking β‐blockers and seven having a permanent pacemaker, no syncopal recurrence was observed. Tilt‐induced asystole that may require resuscitative maneuvers occurs especially in patients with a history of seizures or injury. Therapy with β‐blockers is often effective to prevent induction of syncope as well as recurrences.

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