Why is the Tilt Table Test Still Useful to Define who Should or Should Not Get A Pacemaker with Vasovagal Syncope?

(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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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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Approximate entropy analysis of electroencephalogram in vasovagal syncope on tilt table test

The 26th Annual International Conference of the IEEE Engineering in Medicine and Biology Society ◽

10.1109/iembs.2004.1403226 ◽

2005 ◽

Cited By ~ 1

Author(s):

S.C. Fang ◽

H.L. Chan ◽

W.H. Chen

Keyword(s):

Vasovagal Syncope ◽

Approximate Entropy ◽

Tilt Table Test ◽

Entropy Analysis ◽

Tilt Table

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A04-2 Cardiovascular autonomic regulations in patients with recurrent vasovagal syncope and positive head-upright tilt table test

EP Europace ◽

10.1016/s1099-5129(03)91520-0 ◽

2003 ◽

Vol 4 ◽

pp. B5-B6

Author(s):

J SIMEK

Keyword(s):

Vasovagal Syncope ◽

Tilt Table Test ◽

Tilt Table ◽

Upright Tilt

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Isoproterenol Causing Coronary Vasospasm and ST Elevations During Tilt Table Testing

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709620966862 ◽

2020 ◽

Vol 8 ◽

pp. 232470962096686

Author(s):

Hanh Duong ◽

Omar Maher Masarweh ◽

Grant Campbell ◽

Theingi Tiffany Win ◽

Fowrooz Joolhar

Keyword(s):

Cerebral Perfusion ◽

Carotid Sinus ◽

Vasovagal Syncope ◽

Healthy Woman ◽

Inferior Wall ◽

Cardiovascular Disorders ◽

Tilt Table Test ◽

Tilt Table ◽

Prolonged Standing ◽

Frequent Form

Syncope is a sudden but reversible brief loss of consciousness secondary to an acute reduction of cerebral perfusion. Reflex syncope denotes neurologically mediated syncope, which includes vasovagal, carotid sinus syndrome, and other situational syncope. The most frequent form of syncope is vasovagal, which is triggered by emotional stress or prolonged standing, and may be diagnosed with the tilt table test. A thorough investigation of syncope is necessary as serious cardiovascular disorders may also be a cause. A tilt table test is a widely used tool utilized by clinicians to diagnose vasovagal syncope and is sometimes augmented with isoproterenol, a β-sympathomimetic that acts on the heart. This report seeks to explain a case of a 48-year-old previously healthy woman who experienced inferior wall ST elevations during tilt table test supplemented with isoproterenol. There is reason to believe that the results of this patient’s tilt table test were due to vasovagal syncope in conjunction with right coronary artery vasospasm.

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