tilt-table test – ABC CARDIOL

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Original Article

Does a Role Exist for Tilting-Guided Therapy in the Management of Neurocardiogenic Syncope?

Denise Hachul et al. Mauricio Scanavacca Eduardo Sosa

PURPOSE: Upright tilt-table testing (UTT) is an useful method for identifying patients with neurocardiogenic syncope, but its role in the evaluation of therapeutic efficacy is controversial. The aim of this study was to determine the correlation between negative UTT after therapy introduction (acute efficacy) and symptom recurrence during follow-up (chronic efficacy). METHODS: We studied 56 severely symptomatic patients (age 27±19 years) with recurrent (7±12 episodes) neurocardiogenic syncope (positive UTT). Once empirical pharmacological therapy was initiated, all patients underwent another UTT (therapeutic evaluation test – TET). Therapy was not modified after TET results. The probability of symptom recurrence was analyzed with the Kaplan-Meier method and compared by log-rank test in patients with negative and positive TET. RESULTS: Negative UTT after therapy was related to a significantly lower probability of recurrence during follow-up (4.9 versus 52.4% in 12 months, P<0.0001). CONCLUSION: A good correlation exists between acute and long-term efficacy of pharmacological therapy for neurocardiogenic syncope, so that serial UTT may be considered a good method for identifying an effective therapeutic strategy.

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Original Article

Diagnostic value of the tilt-table test for the assessment of syncope in children and adolescents

Tan Chen Wu et al. Denise Hachul Mauricio Scanavacca Eduardo Sosa

OBJECTIVE – To assess the diagnostic value, the characteristics, and feasibility of tilt-table testing in children and adolescents. METHODS – From August 1991 to June 1997, we retrospectively assessed 94 patients under the age of 18 years who had a history of recurring syncope and presyncope of unknown origin and who were referred for tilt-table testing. These patients were divided into 2 groups: group I (children) – 36 patients with ages ranging from 3 to 12 (mean of 9.19±2.31) years; group II (adolescents) – 58 patients with ages ranging from 13 to 18 (mean of 16.05±1.40) years. We compared the positivity rate, the type of hemodynamic response, and the time period required for the test to become positive in the 2 groups. RESULTS – The positivity rates were 41.6 % and 50% for groups I and II, respectively. The pattern of positive hemodynamic response that predominated in both groups was the mixed response. The mean time period required for the test to become positive was shorter in group I (11.0±7.23 min) than in group II (18.44±7.83 min). No patient experienced technical difficulty or complications. CONCLUSION – No difference was observed in regard to feasibility, positivity rate, and pattern of positive response for the tilt-table test in children and adolescents. Pediatric patients had earlier positive responses.

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Does a Role Exist for Tilting-Guided Therapy in the Management of Neurocardiogenic Syncope?

Diagnostic value of the tilt-table test for the assessment of syncope in children and adolescents

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