Key result
Continuous PAT monitoring during HUTT proves feasible for capturing uninterrupted pulse waveforms during orthostatism.
Why the study?
Conventional HUTT monitoring with intermittent blood pressure and on-demand ECGs may miss key hemodynamic sequences, whereas peripheral arterial tonometry provides continuous, non-invasive pulse waveform monitoring.
Observational (n=41)
No
Continuous peripheral arterial tonometry monitoring during standard head-up tilt table testing is feasible and provides complementary physiological information for characterizing autonomic response patterns in syncope.
Answers are grounded in this paper and cite their sources.
May enhance continuous monitoring during tilt testing; leaves open diagnostic impact and requires validation before practice change.
Introduction: The head-up tilt table test (HUTT) is widely used to reproduce reflex syncope (RS), but conventional monitoring based on intermittent blood pressure (BP) measurements and on-demand electrocardiograms (ECGs) may miss key hemodynamic sequences. Peripheral arterial tonometry (PAT) provides continuous, non-invasive pulse waveform monitoring and may offer complementary physiological information during syncope.Objective: To describe the feasibility of integrating PAT monitoring into a standard HUTT protocol and to characterize the autonomic response patterns observed using this approach.Methods: This was a prospective, single center, descriptive, observational physiological feasibility study including 41 consecutive patients undergoing a standard HUTT protocol between June and August 2022.Peripheral arterial tonometry (WatchPAT ® ) was used exclusively as an adjunct continuous recording method.Outcomes were classified according to VASIS criteria.Continuous variables are reported as medians (IQR) and categorical variables as n (%).Results: The median age was 31 years (IQR 16-37), 58.5% were female, and the median BMI was 23.8 kg/m² (IQR 20.4-26.0).Syncope was reproduced in 19/41 patients (46.3%).The most frequent pattern was VASIS type III (vasodepressor; 10/41, 24.4%), followed by type I (mixed; 7/41, 17.1%) and type II (cardioinhibitory; 1/41, 2.4%); one patient met the criteria for POTS (2.4%).Isosorbide dinitrate was administered in 48.8% of cases.Continuous PAT allowed uninterrupted documentation of pulse waveform dynamics during orthostatism, capturing critical phases when intermittent BP measurements were delayed or unavailable.Conclusions: Continuous PAT monitoring during standard HUTT is feasible and may provide complementary physiological information for the characterization of autonomic response patterns, without replacing continuous hemodynamic reference methods or implying formal diagnostic validation.
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Vanegas-Cadavid et al. (2026) conducted an observational in Suspected reflex syncope (n=41). Continuous peripheral arterial tonometry (WatchPAT®) was evaluated on Feasibility of integrating PAT monitoring into a standard HUTT protocol and characterization of autonomic response patterns. Continuous peripheral arterial tonometry monitoring during standard head-up tilt table testing was feasible and allowed uninterrupted documentation of pulse waveform dynamics during orthostatism, capturing critical phases when intermittent blood pressure measurements were delayed or unavailable.
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