Key result
Very prolonged tilt-induced asystole linked to a 36% syncope recurrence rate.
Why the study?
What is the prognosis and need for pacemaker implantation in patients with very prolonged asystole (≥30 seconds) during a head-up tilt test?
Observational (n=2,247)
Yes
What is the prognosis and need for pacemaker implantation in patients with very prolonged asystole (≥30 seconds) during a head-up tilt test?
Answers are grounded in this paper and cite their sources.
Patients with very prolonged asystole (≥30 seconds) during a head-up tilt test have a benign long-term prognosis with conservative management and generally do not require pacemaker implantation.
BACKGROUND: Clinical significance and prognosis of a cardioinhibitory response to head-up tilt (HUT) test with a very prolonged asystole (≥30 seconds) is poorly studied. Our aim was to evaluate the treatment (including pacemaker implantation) and prognosis (syncope recurrence, syncope-related trauma, and overall mortality) of patients with a very prolonged asystole on a HUT test. METHODS AND RESULTS: A retrospective study was conducted in two centers between January 2003 and December 2013 and included a total of 2,263 consecutive HUT tests (sensitized with isosorbide dinitrate) performed in 2,247 patients with syncope of unknown etiology. Cardioinhibitory response with asystole was observed in 149 (6.6%) of these tests (44.3% women, mean age 37 ± 18 years old, 16.1% in the nonpharmacological phase), with a median duration of asystole of 10 (6-19) seconds. Very prolonged asystole (≥30 seconds) was documented in 11 (0.5%) patients (45% women; mean age 40 ± 19 years; only one in the nonpharmacological phase, 9 minutes after HUT). The longest pause lasted 63 seconds. In all patients, avoidance of triggering factors and physical counterpressure maneuvers were recommended. Telephone follow-up was performed: in one patient, fludrocortisone was started; tilt training was conducted in one patient and none received a pacemaker. After a median follow-up of 42 (30-76) months, four patients (36%) had syncopal recurrences, one patient had a syncope-related injury (scalp laceration), and no patient died.
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Carvalho et al. (2015) conducted an observational in Syncope of unknown etiology (n=2,247). Very prolonged asystole (≥30 seconds) during head-up tilt test was evaluated on Syncope recurrence, syncope-related trauma, and overall mortality. Very prolonged asystole (≥30 seconds) during head-up tilt test occurred in 0.5% of patients with unexplained syncope, and was associated with a 36% rate of syncopal recurrence over 42 months.
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