Response by Levine and Mody to Letter Regarding Article, “Abolish the Tilt Table Test for the Workup of Syncope!”

Abstract Introduction Reflex syncope is the result of an imbalance between the sympathetic and parasympathetic nervous system. The autonomic nervous system has been associated to some forms of atrial fibrillation (AF). Objective The aim of this study was to assess the prevalence of AF in patients with reflex syncope and a positive tilt table test and to identify the type of tilt test response in patients with AF in comparison to patients without AF. Methods We retrospectively studied consecutive patients that underwent a tilt table test at our institution between 2016 and 2019. We selected those patients with a positive test. Patients with an implanted pacemaker at the time of the tilt test and patients followed in a different institution were excluded. Previous diagnoses of AF episodes were assessed. We analysed the clinical characteristics and the tilt table test results according to previous history of AF. Results We studied 49 patients with a positive tilt test. Seven (14.3%) patients had previously diagnosed paroxysmal AF at the time of the tilt table test. Patients with AF were older, had more frequently hypertension, and the tilt test response was more frequently a vasodepressor than mixed or cardioinhibitory response (71.4% vs. 28.6%) (Table). In univariate analysis, age and hypertension were associated with AF, respectively, OR 1.08 (95% CI 1.01–1.17), p=0.034 and OR 10.80 (95% CI 1.19–98.36), p=0.035. A vasodepressor response was also associated with AF (OR 6.25, 95% CI 1.06–36.74, p=0.043). Conclusions Patients with reflex syncope and a positive tilt table test had a higher prevalence of AF than the general population. A vasodepressor response was associated with AF as were age and hypertension, demonstrating the possible impact of the autonomic nervous system and the multifactorial nature of AF. FUNDunding Acknowledgement Type of funding sources: None.

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Time-varying spectral analysis for comparison of HRV and PPG variability during tilt table test

2010 Annual International Conference of the IEEE Engineering in Medicine and Biology ◽

10.1109/iembs.2010.5627476 ◽

2010 ◽

Cited By ~ 8

Author(s):

E Gil ◽

M Orini ◽

R Bailon ◽

J M Vergara ◽

L Mainardi ◽

...

Keyword(s):

Spectral Analysis ◽

Time Varying ◽

Tilt Table Test ◽

Tilt Table

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The role and importance of the tilt table test in pediatrics: Single-center experience and review of literature

Heart and Mind ◽

10.4103/hm.hm_24_20 ◽

2020 ◽

Vol 4 (3) ◽

pp. 75

Author(s):

Zijo Begic ◽

Nedim Begic ◽

Edin Begic ◽

Naida Spahovic

Keyword(s):

Tilt Table Test ◽

Review Of Literature ◽

Single Center ◽

Tilt Table ◽

Single Center Experience

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The Use of Transcranial Doppler during Tilt Table Testing in Children Presenting with Syncope

Journal for Vascular Ultrasound ◽

10.1177/154431670703100203 ◽

2007 ◽

Vol 31 (2) ◽

pp. 81-86 ◽

Cited By ~ 1

Author(s):

Heather A. Nicoletto ◽

Mark W. Ellis ◽

Daniel T. Laskowitz ◽

Ronald J. Kanter ◽

April E. Perry ◽

...

Keyword(s):

Transcranial Doppler ◽

Psychiatric Treatment ◽

Cerebral Arteries ◽

Tilt Table Test ◽

Tilt Table ◽

Multimodal Monitoring ◽

Neurally Mediated Syncope ◽

Middle Cerebral Arteries ◽

Tilt Table Testing ◽

Flow Velocities

Childhood syncope is common, and there are three categories of causes of syncope: noncardiovascular pseudosyncope, cardiovascular syncope, and neurally mediated syncope. Tilt table testing has become a valuable tool in the evaluation for the cause of syncope in children. Adding transcranial Doppler (TCD) to the tilt table test to monitor the middle cerebral arteries (MCA) adds valuable information about the cerebral blood flow during a syncopal episode and can help the physician differentiate between the various causes of syncope. Three children with frequent syncopal episodes were evaluated using tilt table testing with multimodal monitoring, including TCD. One child, during her syncopal episode, had an increase in blood pressure, heart rate, and MCA flow velocities. This finding was consistent with noncardiovascular pseudosyncope, and she was sent for psychiatric treatment. The other two patients had hypotension, bradycardia, a significant decrease in MCA flow velocities, and an increase in pulsatility indices. Additionally, one of them experienced a 6-sec period of asystole. Both were diagnosed with neurally mediated syncope and were placed on fludrocortisone and a water and salt regimen.

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Cardiovascular Autonomic Nervous System Dysfunction in Patients with Systemic Lupus Erythematosus

QJM ◽

10.1093/qjmed/hcaa052.064 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

D A Hussein ◽

A B E Abdelaziz ◽

A M Abdelmoteleb ◽

M A Elserwy ◽

S G Arafa

Keyword(s):

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Autonomic Neuropathy ◽

Autonomic Dysfunction ◽

Lupus Erythematosus ◽

Activity Index ◽

Tilt Table Test ◽

Systemic Lupus ◽

Tilt Table ◽

Increased Risk

Abstract Background involvement of central and peripheral nervous systems are well-documented in SLE but literature on prevalence and pattern of autonomic neuropathy are few. Women with SLE have been found to have 5-8 fold increased risk of coronary heart disease. Autonomic dysfunction in the presence of structural cardiovascular disease is associated with adverse prognosis. Aim of the Work the purpose of this study is to evaluate the cardiovascular autonomic function in patients with Systemic lupus erythematosus, and to correlate it with SLE clinical features. Patients and Methods we conducted our study on one-hundred Egyptian SLE patients diagnosed according to SLICC classification criteria for SLE recruited from rheumatology outpatient clinic and inpatient department at Ain Shams University Hospitals. All the studied patients were subjected to history taking, clinical examination, and laboratory and radiological investigations related to SLE diagnosis and activity. SLE disease activity was assessed by SLE disease activity index-2000 (SLEDAI-2K).Tilt table test was used to assess for presence of cardiovascular autonomic neuropathy. Results we found that fifty (50%) of our SLE patients had symptoms suggestive for autonomic dysfunction, including orthostatic hypotension, palpitation and or Raynaud’s phenomenon. Regarding the result of tilt table test, sixty eight (68%) of the studied SLE patients were found to have positive tilt table responses. By doing the uni-variate analysis for predictors of SLE patients with positive tilt table test, we found that vasculitis, proteinuria, DNA, low TLC and complement levels, high SLEDAI, ESR and urinary P/C all were predictors for positivity of tilt table testing. Conclusion The prevalence of autonomic dysfunction was high among SLE patients.

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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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Postural orthostatic tachycardia syndrome in primary care: diagnosis, treatment and a case of African-American man presenting with POTS

BMJ Case Reports ◽

10.1136/bcr-2019-229824 ◽

2019 ◽

Vol 12 (9) ◽

pp. e229824

Author(s):

Andrew T Del Pozzi ◽

Michael Enechukwu ◽

Svetlana Blitshteyn

Keyword(s):

Heart Rate ◽

Differential Diagnosis ◽

African American ◽

Clinical Features ◽

Orthostatic Intolerance ◽

Treatment Options ◽

Postural Orthostatic Tachycardia Syndrome ◽

Tilt Table Test ◽

Tilt Table ◽

Caucasian Women

Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous autonomic disorder characterised by orthostatic intolerance and a rise in heart rate by at least 30 bpm or an absolute heart rate value of at least 120 bpm within 10 min of standing or during a tilt table test. Overwhelmingly, POTS affects young Caucasian women, which can lead physicians to miss the diagnosis in men or non-white patients. We describe a case of 29-year-old African-American man who developed lightheadedness, generalised weakness, tachycardia and palpitations and was subsequently diagnosed with POTS. We review its clinical features, differential diagnosis, pathophysiology and treatment options. We also emphasise that POTS should be considered as a differential diagnosis in any patient presenting with typical clinical features, who may not be in the usual demographics of the disorder.

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