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

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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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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The Diagnostic Value of Cardiac Deceleration Capacity in Vasovagal Syncope

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.120.008659 ◽

2020 ◽

Vol 13 (12) ◽

Author(s):

Lihui Zheng ◽

Wei Sun ◽

Shangyu Liu ◽

Erpeng Liang ◽

Zhongpeng Du ◽

...

Keyword(s):

Heart Rate ◽

Vasovagal Syncope ◽

Diagnostic Value ◽

Control Group ◽

Vagal Activity ◽

Tilt Table Test ◽

Tilt Table ◽

Good Tool ◽

Deceleration Capacity ◽

Vagal Control

Background: Increased parasympathetic activity is thought to play important roles in syncope events of patients with vasovagal syncope (VVS). However, direct measurements of the vagal control are difficult. The novel deceleration capacity (DC) of heart rate measure has been used to characterize the vagal modulation. This study aimed to assess vagal control in patients with VVS and evaluate the diagnostic value of the DC in VVS. Methods: Altogether, 161 consecutive patients with VVS (43±15 years; 62 males) were enrolled. Tilt table test was positive in 101 and negative in 60 patients. Sixty-five healthy subjects were enrolled as controls. DC and heart rate variability in 24-hour ECG, echocardiogram, and biochemical examinations were compared between the syncope and control groups. Results: DC was significantly higher in the syncope group than in the control group (9.6±3.3 versus 6.5±2.0 ms, P <0.001). DC was similarly increased in patients with VVS with a positive and negative tilt table test (9.7±3.5 and 9.4±2.9 ms, P =0.614). In multivariable logistic regression analyses, DC was independently associated with syncope (odds ratio=1.518 [95% CI, 1.301–1.770]; P =0.0001). For the prediction of syncope, the area under curve analysis showed similar values when comparing single DC and combined DC with other risk factors ( P =0.1147). From the receiver operator characteristic curves for syncope discrimination, the optimal cutoff value for the DC was 7.12 ms. Conclusions: DC>7.5 ms may serve as a good tool to monitor cardiac vagal activity and discriminate VVS, particularly in those with negative tilt table test.

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Polymorphisms in B-Adrenergic Receptors Are Associated with Increased Risk to Have a Positive Head-Up Tilt Table Test in Patients with Vasovagal Syncope

Revista de investigaci�n Cl�nica ◽

10.24875/ric.18002734 ◽

2019 ◽

Vol 71 (2) ◽

Author(s):

Manlio F. Márquez ◽

José Manuel Fragoso ◽

Daniel Pérez-Pérez ◽

Iris Cázares-Campos ◽

Armando Totomoch-Serra ◽

...

Keyword(s):

Adrenergic Receptors ◽

Vasovagal Syncope ◽

Tilt Table Test ◽

Tilt Table ◽

Increased Risk ◽

Head Up Tilt

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Predictors of vasovagal syncope recurrence in children and adolescents and value of head-up tilt table test

Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology ◽

10.5152/akd.2013.194 ◽

2013 ◽

Cited By ~ 1

Author(s):

Sibel Tanriverdi Yilmaz ◽

Koksal Binnetoglu ◽

Kadir Babaoglu ◽

Gurkan Altun

Keyword(s):

Children And Adolescents ◽

Vasovagal Syncope ◽

Tilt Table Test ◽

Tilt Table ◽

Head Up Tilt

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A higher proportion of men than of women fainted in the phase without nitroglycerin in tilt-induced vasovagal syncope

Clinical Autonomic Research ◽

10.1007/s10286-020-00666-5 ◽

2020 ◽

Vol 30 (5) ◽

pp. 441-447 ◽

Cited By ~ 1

Author(s):

Maryam Ghariq ◽

Roland D. Thijs ◽

L. Martine Bek ◽

Erik W. van Zwet ◽

David G. Benditt ◽

...

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Vasovagal Syncope ◽

Binary Logistic Regression ◽

Pressure Change ◽

Tilt Table Test ◽

Tilt Table ◽

History Of ◽

Head Up Tilt ◽

Unexpected Findings

Abstract Purpose Vasovagal syncope (VVS) affects more women than men. We determined whether this sex ratio affects tilt table test (TTT) results. Methods We retrospectively studied TTT outcomes in suspected VVS. TTT consisted of supine rest, a maximum 20 min of head-up tilt without and, if nitroglycerin was needed, a further maximum 20 min after nitroglycerin administration. TTT was terminated if VVS occurred. We used binary logistic regression for the entire TTT and for each phase, with VVS as outcome and age and sex as predictors. Results TTT provoked vasovagal (pre)syncope in 494 out of 766 tests (64%). The proportion of men and women who fainted during the entire TTT did not differ significantly between the sexes (p = 0.13, corrected for age). A lower proportion of women than men had VVS in the phase without nitroglycerin (odds ratio 0.54; 95% confidence interval 0.37–0.79; p = 0.002, corrected for age), whereas a higher proportion of women than men fainted after nitroglycerin (odds ratio 1.58; 95% confidence interval 1.13–2.21; p = 0.008, corrected for age). These sex differences remained significant after correction for a history of orthostatic versus emotional triggers. The effect of sex on TTT outcome was closely associated with differences of blood pressure change upon tilt-up (lower in men in both TTT phases: without nitroglycerin p = 0.003; with nitroglycerin p = 0.05), but not with heart rate changes. Conclusion Men were more susceptible to induction of VVS without nitroglycerin and women after it. The unexpected findings may be due to sex-specific pathophysiological differences.

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Byung Gyu Kim et al.: Reduced systemic vascular resistance is the underlying hemodynamic mechanism in nitrate-stimulated vasovagal syncope during head-up tilt-table test

Journal of Arrhythmia ◽

10.1016/j.joa.2016.04.001 ◽

2017 ◽

Vol 33 (1) ◽

pp. 6

Author(s):

Arttu Eräranta ◽

Antti Tikkakoski ◽

Ilkka H. Pörsti

Keyword(s):

Systemic Vascular Resistance ◽

Vascular Resistance ◽

Vasovagal Syncope ◽

Tilt Table Test ◽

Tilt Table ◽

Head Up Tilt

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Correlation of Postural Blood Pressure Test and Head-Up Tilt Table Test in Patients with Vasovagal Syncope

Cardiology ◽

10.1159/000099056 ◽

2007 ◽

Vol 107 (4) ◽

pp. 380-385 ◽

Cited By ~ 1

Author(s):

Muhammet Ali Aydin ◽

Kai Mortensen ◽

Thomas Meinertz ◽

Andreas Schuchert ◽

Stephan Willems ◽

...

Keyword(s):

Blood Pressure ◽

Vasovagal Syncope ◽

Tilt Table Test ◽

Tilt Table ◽

Pressure Test ◽

Head Up Tilt

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Head Up Tilt Table Test. Short versus Long Protocol

10.5083/ejcm20424884.179 ◽

2020 ◽

Author(s):

Maha Mohamed Mohamed Khalifa ◽

Emad Effat Fakhr

Keyword(s):

Vasovagal Syncope ◽

Tilt Table Test ◽

Tilt Table ◽

Protocol Group ◽

Significant Difference ◽

Cardiogenic Syncope ◽

History Of ◽

Head Up Tilt ◽

Underlying Causes ◽

Long Protocol

ABSTRACT Background: Vasovagal syncope is the most common cause of cardiac related syncope. Meticulous history taking and stepladder multi- investigatory tools are necessary to detect the underlying causes. However, in view of cardiologist’s busy day, a short protocol of Head up tilt table test could save effort and money. Objective: To evaluate the effectiveness of short timed protocol of Head Up Tilt (HUT) table test versus the traditional long protocol in assessment of neuro-cardiogenic syncope. Methods: The current study was conducted among 138 patients with history of syncope or pre-syncope, referred for HUT test during the study period from February 2019 to January 2020. A complete general and local examination and 12 leads baseline ECG was carried out. Patients were randomly divided into two groups- Conventional HUT test with 15 minutes long protocol group with 75 patients and modified short HUT test (10 minutes’ protocol) group with 63 patients. Results: No significant differences were observed in the test outcomes between both groups. However, a significant difference was observed in the mean patient recovery time in short protocol (2.64±1.35 minutes) as compared to the long protocol (4.05±1.19l minutes) (P <0.001). Conclusion: Applying the short timed protocol in tilt table testing is considered as effective as doing the traditional long protocol and would not affect the test results. The short protocol improved the patient wellbeing and helped in saving time and effort.

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A clinical manifestation-based prediction of haemodynamic patterns of orthostatic intolerance in children: a multi-centre study

Cardiology in the Young ◽

10.1017/s1047951113000929 ◽

2013 ◽

Vol 24 (4) ◽

pp. 649-653 ◽

Cited By ~ 6

Author(s):

Li Chen ◽

Xueying Li ◽

Ochs Todd ◽

Cheng Wang ◽

Hongfang Jin ◽

...

Keyword(s):

Clinical Study ◽

Diagnostic Accuracy ◽

Clinical Manifestation ◽

Orthostatic Intolerance ◽

Vasovagal Syncope ◽

Postural Orthostatic Tachycardia Syndrome ◽

Tilt Table Test ◽

Tilt Table ◽

Multi Centre Study ◽

Head Up Tilt

AbstractObjective: At present, the haemodynamic diagnosis of orthostatic intolerance is based mainly on the head-up tilt table test, which is sometimes risky for patients. Thus, it is important to find objective and safe methods to differentiate haemodynamic patterns of orthostatic intolerance cases. Methods: In all, 629 children with orthostatic intolerance, either vasovagal syncope or postural orthostatic tachycardia syndrome, were included in the multi-centre clinical study. We analysed the association between the clinical manifestation and haemodynamic patterns of the patients. Results: Syncope after motion with a prodrome of chest distress or palpitations and the concomitant symptom(s) after a syncopal attack, with debilitation, dizziness or headache, were the most important variables in predicting the diagnosis of vasovagal syncope. The overall diagnostic accuracy was 71.5%. Conclusion: Complaint of syncope after motion with prodromal chest distress or palpitation and the concomitant symptom after a syncopal attack, with subsequent debilitation, dizziness or headache, were the most important variables in the diagnosis of vasovagal syncope in children with orthostatic intolerance.

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