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
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.