Safety and tolerability of an aggressive tilt table test protocol in the evaluation of patients with suspected neurocardiogenic syncope

Citation
Sc. Vlay et al., Safety and tolerability of an aggressive tilt table test protocol in the evaluation of patients with suspected neurocardiogenic syncope, PACE, 23(4), 2000, pp. 441-445
Citations number
20
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY
ISSN journal
01478389 → ACNP
Volume
23
Issue
4
Year of publication
2000
Part
1
Pages
441 - 445
Database
ISI
SICI code
0147-8389(200004)23:4<441:SATOAA>2.0.ZU;2-U
Abstract
Safety and tolerability of a one-step tilt table test with high dose(5 mu g /min) isoproterenol (ISO) without intermediate stages were evaluated in a s ymptomatic population of 300 patients referred for clinical syncope, near s yncope, or dizziness. ISO has been used as a provocative test but remains c ontroversial. A population of 118 male and 182 female patients with a mean age of 45 (range 5-90) years underwent 300 tests. Heart rate and blood pres sure were monitored continuously. A positive test was one in which clinical symptoms were reproduced or hemodynamic criteria met. Patients were initia lly supine for 5 minutes followed by head upright tilt (HUT) to an angle of 80 degrees for 10 minutes. Negative tests were repeated with an infusion o f lSO at a rate of 5 mu g/min. HUT was positive in 133 (44.3%) of 300 tests . With a 10-minute HUT alone, only 17 (5.7%) of 300 of tests were positive. Of the initial negative tests, 273 of 283 were tested with ISO. With ISO, 116 (42.5%) of 273 were positive. ISO in high dose (5 mu g/min) was used in 264 of 273 patients, while low dose (1.0-2.5 mu g/min) was used in 9 of 27 3 under special circumstances. High dose ISO was tolerated in 164 (62.1%) o f 264 patients, reduced in 87 (33%) of 264, and discontinued in 11 (4.2%) o f 264. Reasons for reduction included tachycardia (40 patients), nausea (31 patients), chest pain (2 patients), arrhythmia (5 patients), or other (9 p atients). Adverse effects resolved within 1 minute of dose reduction. This one-step high dose ISO protocol reproduced neurocardiogenic syncope in symp tomatic patients who tested negative without ISO and was safe, tolerated, a nd expeditious.