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Safety and Tolerability of an Aggressive Tilt Table Test Protocol in the Evaluation of Patients with Suspected Neurocardiogenic Syncope
Author(s) -
VLAY STEPHEN C.,
BRODSKY CRAIG,
VLAY LINDA C.
Publication year - 2000
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.1540-8159.2000.tb00824.x
Subject(s) - medicine , tolerability , supine position , anesthesia , nausea , syncope (phonology) , heart rate , blood pressure , tachycardia , population , adverse effect , environmental health
Safety and tolerability of a one‐step tilt table test with high dose (5 μg/min) isoproterenol (ISO) without intermediate stages were evaluated in a symptomatic population of 300 patients referred for clinical syncope, near syncope, or dizziness. ISO has been used as a provocative test but remains controversial. A population of 118 male and 182 female patients with a mean age of 45 (range 5–90) years underwent 300 tests. Heart rate and blood pressure were monitored continuously. A positive test was one in which clinical symptoms were reproduced or hemodynamic criteria met. Patients were initially supine for 5 minutes followed by head upright tilt (HUT) to an angle of 80± for 10 minutes. Negative tests were repeated with an infusion of ISO at a rate of 5 μg/min, HUT was positive in 133 (44.3%) of 300 tests. With a 10‐minute HUT alone, only 17 (5.7%) of 300 of tests were positive. Of the initial negative tests, 273 of 283 were tested with ISO. With ISO, 116(42.5%) of 273 were positive. ISO in high dose (5 μg/min) was used in 264 of 273 patients, while low dose (1.0–2.5 μg/min) was used in 9 of 273 under special circumstances. High dose ISO was tolerated in 164 (62.1 %) of 264 patients, reduced in 87 (33%) of 264, and discontinued in 11 (4.2 %) of 264. Reasons for reduction included tachycardia (40 patients), nausea (31 patients), chest pain (2 patients), arrhythmia (5 patients), or other (9 patients). Adverse effects resolved within 1 minute of dose reduction. This one‐step high dose ISO protocol reproduced neurocardiogenic syncope in symptomatic patients who tested negative without ISO and was safe, tolerated, and expeditious.