VALUE OF TILT TESTING IN THE ETIOLOGIC DI AGNOSIS OF SYNCOPE UNEXPLAINED BY ELECTROPHYSIOLOGICAL INVESTIGATION

In order to determine the role of tilt testing in the aetiological dia gnosis of syncope unexplained by electrophysiological investigation, t he authors retrospectively studied the results of this test in 275 pat ients with a mean age of 64 +/- 16 years. These 275 patients were divi ded into two groups: group 1: 43 patients with a mean age of 50 +/- 19 years presenting with vagal syncopes, group ll: 232 patients with une xplained syncope, probably vagal: group lla (120 patients, mean age: 6 7 +/- 15 years), sudden syncope: group llb (112 patients, mean age: 67 +/- 13 years). The electrophysiological investigation was inconclusiv e in every case. In group ll, 50% of tilt tests were positive (19% und er basal conditions, 31% after isoproterenol), with 61% of positive te sts in group lla, including 31% on the basal test, and 38% of positive tests in group llb, including 11% on the basal test. In group l, 84% of tests were positive (33% on the basal test, 51% after isoproternol) , indicating a sensitivity of the test of 84%. In 96 patients with a d oubtful electrophysiological investigation, the tilt test was positive in 70% of cases, allowing specific treatment or a pacemaker to be avo ided in the majority of cases. 84% of vasvagal syncopes were therefore confirmed by tilt testing; 50% of syncopes unexplained by electrophys iological investigation were demonstrated to be of vasovagal origin. T he authors emphasize the value of tilt testing in certain discordant s ituations in which the clinical context is disturbing and/or electroph ysiological investigation is not completely reassuring.