Usefulness of post-procedural heart rate response to predict syncope recurrence or positive head up tilt table testing after cardioneuroablation

Abstract Aims Previous reports have suggested that cardioneuroablation (CNA) can be effective in reducing syncopal recurrences in patients with vasovagal syncope (VVS). This study assessed the efficacy of CNA in preventing a positive response to head-up tilt testing (HUT). Methods and results This is a single-centre retrospective study reviewing prospectively collected data. Fifty-one consecutive patients with VVS were included in the study. After confirmation of >3 s asystole on HUT, all patients underwent CNA. Head-up tilt testing was repeated 1 month after CNA. The main outcome measures were recurrence of syncope episode and positive response on HUT. During a median follow-up period of 11 months (interquartile range 3–27 months), all but 3 (5.8%) of 51 patients were free of syncope. Repeated HUTs were negative in 44 (86.2%) patients. When patients with recurrent syncope were excluded, vasodepressor response was seen in three cases and cardioinhibitory response in one case, respectively. Cardioneuroablation caused significant and durable shortening of RR interval in all cases. This effect was significantly higher in patients without positive HUT responses. Conclusion This pilot study shows that CNA can effectively prevent recurrent syncopal episodes in patients with refractory VVS. Head-up tilt testing seems as a valuable diagnostic tool not only to select suitable candidates and but also to evaluate success of CNA.

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A01-4 Response to head-up tilt testing and follow-up in patients with situational syncope; Comparison with vasovagal syncope

EP Europace ◽

10.1016/s1099-5129(03)91505-4 ◽

2003 ◽

Vol 4 ◽

pp. B1-B2

Author(s):

D LEFTHERIOTIS

Keyword(s):

Vasovagal Syncope ◽

Tilt Testing ◽

Head Up Tilt

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Situational Syncope:. Response to Head-Up Tilt Testing and Follow-Up: Comparison with Vasovagal Syncope

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.2004.00559.x ◽

2004 ◽

Vol 27 (7) ◽

pp. 918-923 ◽

Cited By ~ 8

Author(s):

EFTHIMIOS G. LIVANIS ◽

DIONYSSIOS LEFTHERIOTIS ◽

GEORGE N. THEODORAKIS ◽

PANAGIOTA FLEVARI ◽

ELIAS ZARVALIS ◽

...

Keyword(s):

Vasovagal Syncope ◽

Tilt Testing ◽

Head Up Tilt

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P1101Is there any link between vitamin D deficiency and vasovagal syncope?

EP Europace ◽

10.1093/europace/euaa162.245 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

S Usalp ◽

H Kemal ◽

U Yuksek ◽

B Yaman ◽

A Gunsel ◽

...

Keyword(s):

Vitamin D ◽

Vasovagal Syncope ◽

Female Gender ◽

P Value ◽

Negative Group ◽

Tilt Table ◽

Tilt Testing ◽

Head Up Tilt ◽

Chemiluminescent Microparticle Immunoassay ◽

Echocardiographic Findings

Abstract Background This study aimed to investigate serum 25[OH]D levels between patients with vasovagal syncope(VVS) diagnosed by head-up tilt table test (HUTT) and patients who do not develop syncope during the test. Methods Sixty-eight consecutive patients [mean age 33.2 ± 14.5 years, 49 females (72.1%)] were categorized based on their HUTT results (positive vs. negative, n = 40 vs. 28).25[OH]D levels were measured by chemiluminescent microparticle immunoassay method in all patients. Results There was no difference between the two groups in terms of blood tests, Body Mass Index, gender, echocardiographic findings(p > 0.05).Mean 25[OH]D level was lower in HUTT positive patients when compared to the HUTT negative group(p < 0.05).25[OH]D levels were significantly lower between patients over the age 25 in two groups (mean level 17.9 ± 7.3 vs 26.3 ± 8.5, respectively,p < 0.005).(Table 1) Conclusion We found that patients diagnosed VVS by HUTT test had lower 25[OH]D levels.Measurement of vitamin D level may be an important factor in VVS patients. Table 1 Head-up Tilt Testing positive (n = 40) negative (n = 28) p value Age (years) 33.2 ± 13.7 33.3 ± 15.9 0.973 Female gender (%) 31 (77.5) 18(64.3) 0.232 BMI (kg/m2) 23.4 ± 3.1 23.0 ± 2.6 0,596 EF (%) 59.2 ± 1.6 59.1 ± 1.3 0.357 LA (mm) 34 ± 2.4 33 ± 2.7 0.715 RA (mm) 32 ± 2.5 31 ± 2.7 0.141 Vitamin D (ng/mL) 16.5 ± 6.6 23.9 ± 9.5 0.001 Vitamin B12 (pg/mL) 355.1 ± 124.6 378 ± 87.0 0.367 TSH (mIU/L) 1.8 ± 0.8 1.7 ± 0.9 0.367 Glucose (mg/dL) 87.0 ± 7.4 90.5 ± 8.1 0.076 Creatinine (mg/dL) 0.6 ± 0.1 0.7 ± 0.1 0..55 Sodium (mmol/L) 139.8 ± 2.0 139.7 ± 2.5 0.931 Potassium (mmol/L) 4.1 ± 0.3 4.1 ± 0.2 0.674 Calcium (mg/dL) 8.9 ± 0.9 8.9 ± 1.1 0.476 Wbc (x103/uL) 7.3 ± 1.6 6.9 ± 1.6 0.339 Hb (g/dL) 13.3 ± 1.3 13.5 ± 1.8 0.664 Age (years) Vitamin D level Vitamin D level 0.132 ≤ 25 (n = 31) 14.8 ± 5.5 21.2 ± 10.2 0.057 > 25 (n = 37) 17.9 ± 7.3 26.3 ± 8.5 0.005 Patients characteristics of Head-up Tilt Testing positive and negative group

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A01-4 Response to head-up tilt testing and follow-up in patients with situational syncope; Comparison with vasovagal syncope

EP Europace ◽

10.1016/eupace/4.supplement_2.b1-c ◽

2003 ◽

Vol 4 (Supplement_2) ◽

pp. B1-B2

Author(s):

D. Leftheriotis ◽

E.G. Livanis ◽

G.N. Theodorakis ◽

P. Flevari ◽

E. Zarvalis ◽

...

Keyword(s):

Vasovagal Syncope ◽

Tilt Testing ◽

Head Up Tilt

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P.2.5 Should patients, with recurrent VVS and asystolic response during head up tilt testing receive a pacemaker implantation? The vasovagal syncope and pacing trial (synpace)

EP Europace ◽

10.1016/s1099-5129(02)90183-2 ◽

2003 ◽

Vol 4 ◽

pp. A41

Author(s):

M CELESTRE

Keyword(s):

Vasovagal Syncope ◽

Pacemaker Implantation ◽

Tilt Testing ◽

Head Up Tilt

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P1514 Nitrate stimulate head up tilt testing potentiates the predictive value of the tilt test on the risk of recurrence in patients with vasovagal syncope

European Heart Journal ◽

10.1016/s0195-668x(03)94652-5 ◽

2003 ◽

Vol 24 (5) ◽

pp. 271

Author(s):

A AERTS

Keyword(s):

Predictive Value ◽

Vasovagal Syncope ◽

Tilt Test ◽

Risk Of Recurrence ◽

Tilt Testing ◽

Head Up Tilt

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The Differences in the Diagnostic Profile in Children with Vasovagal Syncope between the Result of Head-Up Tilt Table Test

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17124524 ◽

2020 ◽

Vol 17 (12) ◽

pp. 4524

Author(s):

Ewelina Kolarczyk ◽

Lesław Szydłowski ◽

Agnieszka Skierska ◽

Grażyna Markiewicz-Łoskot

Keyword(s):

Medical Records ◽

Vasovagal Syncope ◽

Speech Disorders ◽

Tilt Table Test ◽

Tilt Table ◽

Prodromal Symptoms ◽

Close Relationship ◽

Head Up Tilt ◽

Diagnostic Profile ◽

Positive Results

(1) Background: The features characterizing vasovagal syncope (VVS) are an important factor in the correct evaluation of diagnostic risk stratification in children and adolescents. The aim of the study was to determine the value of identifying the clinical characteristics in children with VVS. (2) Methods: We made a retrospective analysis of the medical records of 109 children with diagnosed VVS. We investigated the specific characteristics of syncope in children with VVS including the positive VVS (+) and negative VVS (−) result of the Head-Up Tilt Table Test (HUTT). (3) Results: We did not observe significant differences in the prodromal symptoms of VVS with HUTT response. In addition to typical prodromal symptoms, no difference in statistically reported palpitations (35/109 or 32.1%) and chest discomfort (27/109 or 27.7%) were recorded. Fear–pain–stress emotions as circumstances of syncope were more often reported by children with a negative HUTT (p = 0.02). Cramps–contractures (p = 0.016) and speech disorders (p = 0.038) were significantly higher in the group with negative HUTT. (4) Conclusions: There is a close relationship in the diagnostic profile between the negative and positive results of head-up tilt table test in children with vasovagal syncope.

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Prolongation of Electrocardiographic T Wave Parameters Recorded during the Head-Up Tilt Table Test as Independent Markers of Syncope Severity in Children

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17186441 ◽

2020 ◽

Vol 17 (18) ◽

pp. 6441

Author(s):

Grażyna Markiewicz-Łoskot ◽

Ewelina Kolarczyk ◽

Bogusław Mazurek ◽

Marianna Łoskot ◽

Lesław Szydłowski

Keyword(s):

Vasovagal Syncope ◽

The Other ◽

Control Group ◽

Tilt Table Test ◽

Tilt Table ◽

T Wave ◽

Good Discriminator ◽

Wave Morphology ◽

Head Up Tilt ◽

T Waves

The head-up tilt table test (HUTT) with the upright phase is used to help determine an imbalance of the sympathetic nervous system that is related to abnormal electrocardiographic repolarization in children with vasovagal syncope (VVS) and also in patients with the long QT syndrome (LQTS). The study attempted to evaluate T wave morphology and QT and TpTe (Tpeak–Tend) intervals recorded in ECG during the HUTT for a more accurate diagnosis of children with VVS. The group investigated 70 children with a negative HUTT result: 40 patients with VVS and 30 healthy volunteers without syncope. The RR interval as well as TpTe, and QTc intervals were measured in lead V5 of electrocardiogram (ECG) on admission to the hospital and during three phases of the HUTT. In syncopal children, which included 23 children with bifid or flat T waves and 17 patients with normal T waves in the upright phase, the QTc and TpTe were longer (p < 0.001) compared to the other test phases and longer (p < 0.001) than in the control group, respectively, with the risk of arrhythmias. Only in the control group, the TpTe was shorter (p < 0.001) in the upright phase than in the other tilt phases. The TpTe in the upright phase (>70 ms) was a good discriminator, and was better than the QTc (>427 ms). Prolongation of electrocardiographic TpTe and QT intervals, in addition to the (abnormal T wave morphology recorded during the HUTT, are helpful for identifying VVS children more predisposed to ventricular arrhythmias with a latent risk of LQTS. Further studies are required to assess the value of these repolarization parameters in clinical practice.

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