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Prevalence of asystole during tilt test-induced vasovagal syncope may depend on test methodology

Russo, Vincenzo ; Parente, Erika ; Groppelli, Antonella ; Rivasi, Giulia ; Tomaino, Marco ; Gargaro, Alessio ; Giacopelli, Daniele ; Ungar, Andrea ; Parati, Gianfranco and Fedorowski, Artur LU orcid , et al. (2023) In Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 25(2). p.263-269
Abstract

This review addresses tilt-testing methodology by searching the literature which reports timing of asystole and loss of consciousness (LOC). Despite the Italian protocol being the most widely adopted, its stipulations are not always followed to the letter of the European Society of Cardiology guidelines. The discrepancies permit reassessment of the incidence of asystole when tilt-down is early, impending syncope, compared with late, established LOC. Asystole is uncommon with early tilt down and diminishes with increasing age. However, if LOC is established as test-end, asystole is more common, and it is age-independent. Thus, the implications are that asystole is commonly under-diagnosed by early tilt-down. The prevalence of asystolic... (More)

This review addresses tilt-testing methodology by searching the literature which reports timing of asystole and loss of consciousness (LOC). Despite the Italian protocol being the most widely adopted, its stipulations are not always followed to the letter of the European Society of Cardiology guidelines. The discrepancies permit reassessment of the incidence of asystole when tilt-down is early, impending syncope, compared with late, established LOC. Asystole is uncommon with early tilt down and diminishes with increasing age. However, if LOC is established as test-end, asystole is more common, and it is age-independent. Thus, the implications are that asystole is commonly under-diagnosed by early tilt-down. The prevalence of asystolic responses observed using the Italian protocol with a rigorous tilt down time is numerically close to that observed during spontaneous attacks by electrocardiogram loop recorder. Recently, tilt-testing has been questioned as to its validity but, in selection of pacemaker therapy in older highly symptomatic vasovagal syncope patients, the occurrence of asystole has been shown to be an effective guide for treatment. The use of head-up tilt test as an indication for cardiac pacing therapy requires pursuing the test until complete LOC. This review offers explanations for the findings and their applicability to practice. A novel interpretation is offered to explain why pacing induced earlier may combat vasodepression by raising the heart rate when sufficient blood remains in the heart.

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type
Contribution to journal
publication status
published
in
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
volume
25
issue
2
pages
263 - 269
publisher
Oxford University Press
external identifiers
  • pmid:36796797
  • scopus:85148253064
ISSN
1532-2092
DOI
10.1093/europace/euac154
language
English
LU publication?
no
additional info
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.
id
3b3adef6-622e-4a28-acec-256ce25345bd
date added to LUP
2023-02-18 10:11:26
date last changed
2024-04-19 20:16:43
@article{3b3adef6-622e-4a28-acec-256ce25345bd,
  abstract     = {{<p>This review addresses tilt-testing methodology by searching the literature which reports timing of asystole and loss of consciousness (LOC). Despite the Italian protocol being the most widely adopted, its stipulations are not always followed to the letter of the European Society of Cardiology guidelines. The discrepancies permit reassessment of the incidence of asystole when tilt-down is early, impending syncope, compared with late, established LOC. Asystole is uncommon with early tilt down and diminishes with increasing age. However, if LOC is established as test-end, asystole is more common, and it is age-independent. Thus, the implications are that asystole is commonly under-diagnosed by early tilt-down. The prevalence of asystolic responses observed using the Italian protocol with a rigorous tilt down time is numerically close to that observed during spontaneous attacks by electrocardiogram loop recorder. Recently, tilt-testing has been questioned as to its validity but, in selection of pacemaker therapy in older highly symptomatic vasovagal syncope patients, the occurrence of asystole has been shown to be an effective guide for treatment. The use of head-up tilt test as an indication for cardiac pacing therapy requires pursuing the test until complete LOC. This review offers explanations for the findings and their applicability to practice. A novel interpretation is offered to explain why pacing induced earlier may combat vasodepression by raising the heart rate when sufficient blood remains in the heart.</p>}},
  author       = {{Russo, Vincenzo and Parente, Erika and Groppelli, Antonella and Rivasi, Giulia and Tomaino, Marco and Gargaro, Alessio and Giacopelli, Daniele and Ungar, Andrea and Parati, Gianfranco and Fedorowski, Artur and Sutton, Richard and van Dijk, J Gert and Brignole, Michele}},
  issn         = {{1532-2092}},
  language     = {{eng}},
  month        = {{02}},
  number       = {{2}},
  pages        = {{263--269}},
  publisher    = {{Oxford University Press}},
  series       = {{Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology}},
  title        = {{Prevalence of asystole during tilt test-induced vasovagal syncope may depend on test methodology}},
  url          = {{http://dx.doi.org/10.1093/europace/euac154}},
  doi          = {{10.1093/europace/euac154}},
  volume       = {{25}},
  year         = {{2023}},
}