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Does a role exist for tilting-guided therapy in the management of neurocardiogenic syncope?
Denise Hachul1, Mauricio Scanavacca, Eduardo Sosa
1Heart Institute, São Paulo University, São Paulo, SP, Brazil. dhachul@incor.usp.br
Purpose:
Upright tilt-table testing (UTT) is an useful method for identifying patients with neurocardiogenic syncope, but its role in the evaluation of therapeutic efficacy is controversial. The aim of this study was to determine the correlation between negative UTT after therapy introduction (acute efficacy) and symptom recurrence during follow-up (chronic efficacy).
Methods:
We studied 56 severely symptomatic patients (age 27 +/- 19 years) with recurrent (7 +/-12 episodes) neurocardiogenic syncope (positive UTT). Once empirical pharmacological therapy was initiated, all patients underwent another UTT (therapeutic evaluation test - TET). Therapy was not modified after TET results. The probability of symptom recurrence was analyzed with the Kaplan-Meier method and compared by log-rank test in patients with negative and positive TET.
Results:
Negative UTT after therapy was related to a significantly lower probability of recurrence during follow-up (4.9 versus 52.4% in 12 months, P<0.0001).
Conclusion:
A good correlation exists between acute and long-term efficacy of pharmacological therapy for neurocardiogenic syncope, so that serial UTT may be considered a good method for identifying an effective therapeutic strategy.