A study of head-up tilt evaluation of syncope and presyncope in patients with and without structural heart disease

Objective: The objective is to assess the prevalence of vasovagal syncope (VVS) in patients with history of syncope and/or presyncope and to study the response to head up tilt test (HUTT) in patients with structural heart disease and stable arrhythmia. Methods: This is a prospective, observational study conducted in the Department of Cardiology, Govt Medical College, Kozhikode, from April 2024 to April 2025. A total of 87 patients with syncope or presyncope presenting to the department were enrolled. All the participants underwent detailed history taking, blood investigations, electrocardiogram (ECG), two-dimensional-echo, 24-h Holter, and HUTT. Results: The majority of patients enrolled were males, in the age group of 15–30 years. The vast majority had premonitory symptoms. HUTT was positive in 67.8% of the patients. The most common response was type III vasodepressive response. The presence of comorbidities was found to have a strong association with positive HUTT response. Patients with underlying structural heart disease and those with baseline ECG changes had a higher likelihood of developing a positive HUTT. Multivariate analysis revealed that age and the presence of comorbidities, like diabetes mellitus, were significant predictors of VVS. Conclusions: The prevalence of VVS among the study population was 68%. Patients with hypertrophic cardiomyopathy and ECG changes, such as sinus bradycardia and Brugada pattern, have a higher likelihood of developing VVS. Accurate diagnosis of VVS, particularly in such patients, may help avoid inadvertent device therapy.