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Prognostic Value of a Very Prolonged Asystole during Head‐Up Tilt Test
Author(s) -
CARVALHO MARIA SALOMÉ,
REIS SANTOS KATYA,
CARMO PEDRO,
CAVACO DIOGO,
PARREIRA LEONOR,
MORGADO FRANCISCO,
ADRAGÃO PEDRO
Publication year - 2015
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/pace.12656
Subject(s) - asystole , medicine , anesthesia , syncope (phonology) , implantable loop recorder , tilt table test , cardiology , surgery , heart rate , blood pressure , atrial fibrillation
Background Clinical significance and prognosis of a cardioinhibitory response to head‐up tilt (HUT) test with a very prolonged asystole ( ≥ 30 seconds) is poorly studied. Our aim was to evaluate the treatment (including pacemaker implantation) and prognosis (syncope recurrence, syncope‐related trauma, and overall mortality) of patients with a very prolonged asystole on a HUT test. Methods and Results A retrospective study was conducted in two centers between January 2003 and December 2013 and included a total of 2,263 consecutive HUT tests (sensitized with isosorbide dinitrate) performed in 2,247 patients with syncope of unknown etiology. Cardioinhibitory response with asystole was observed in 149 (6.6%) of these tests (44.3% women, mean age 37 ± 18 years old, 16.1% in the nonpharmacological phase), with a median duration of asystole of 10 (6–19) seconds. Very prolonged asystole ( ≥ 30 seconds) was documented in 11 (0.5%) patients (45% women; mean age 40 ± 19 years; only one in the nonpharmacological phase, 9 minutes after HUT). The longest pause lasted 63 seconds. In all patients, avoidance of triggering factors and physical counterpressure maneuvers were recommended. Telephone follow‐up was performed: in one patient, fludrocortisone was started; tilt training was conducted in one patient and none received a pacemaker. After a median follow‐up of 42 (30–76) months, four patients (36%) had syncopal recurrences, one patient had a syncope‐related injury (scalp laceration), and no patient died.