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Updated: Jul 19, 2026
11:40
Quantitative Autonomic Testing
Published on: July 19, 2011
Significant complications can occur with ischemic heart disease and tilt table testing
R B Leman1, E Clarke, P Gillette
1Medical University of South Carolina, Charleston 294225, USA.
Pacing and Clinical Electrophysiology : PACE
|May 11, 1999
Summary
Tilt table testing with isoproterenol can induce ventricular fibrillation in patients with coronary artery disease. Prompt cardioversion and subsequent treatment of coronary artery disease prevented further arrhythmias.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Syncope evaluation in elderly patients with known coronary artery disease (CAD) and conduction abnormalities.
- Initial suspicion of vasovagal reaction prompted tilt table testing.
Observation:
- During tilt table testing with isoproterenol, the patient experienced ventricular fibrillation.
- Ventricular fibrillation was immediately resolved with cardioversion.
Findings:
- The patient was subsequently diagnosed with significant coronary artery disease.
- Percutaneous coronary intervention (PCI) with stenting and angioplasty successfully treated the CAD.
- Post-treatment electrophysiology testing showed no inducible arrhythmias on maximal isoproterenol dose.
Implications:
- Tilt table testing with isoproterenol carries a risk of inducing ventricular arrhythmias, particularly in patients with underlying ischemia.
- Careful consideration of patient's cardiac history is crucial before performing provocative electrophysiology testing.
- This case highlights the importance of evaluating for ischemia before or during provocative testing in at-risk populations.
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