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Related Experiment Videos

Simplified tilt table test protocol with continuous upright position during medication administration and no

John D Fisher1, Soo G Kim, Kevin J Ferrick

  • 1Montefiore Medical Center and Albert Einstein College of Medicine, Department of Medicine, Cardiology Division, Arrhythmia Service, North 2, 111 E. 210th St., Bronx, NY 10467, USA. jfisher@montefiore.org

Pacing and Clinical Electrophysiology : PACE
|April 12, 2003
PubMed
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A simplified head-up tilt testing (HUT) protocol using abbreviated fasting and medication administration in the tilted position is feasible. This approach may reduce testing time without compromising safety or efficacy for vasovagal response diagnosis.

Area of Science:

  • Cardiology
  • Clinical Physiology

Background:

  • Standard head-up tilt testing (HUT) protocols often involve prolonged fasting (nothing by mouth [NPO]) and intravenous fluid restrictions.
  • Supine equilibration periods are typically recommended before and between medication administrations during HUT.

Purpose of the Study:

  • To evaluate the feasibility and outcomes of a simplified HUT protocol.
  • To determine if similar diagnostic results can be achieved with a shorter fasting period and medication administration in the tilted position.

Main Methods:

  • 1,540 HUTs were performed after a 2-3 hour NPO period.
  • Pharmacological agents including isoproterenol (ISO), nitroglycerin (NTG), or edrophonium (EDP) were administered while patients remained in the tilted position.
  • Patients were monitored for predetermined endpoints and adverse effects.

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Main Results:

  • No adverse events related to the abbreviated fasting were observed.
  • Isoproterenol was well tolerated, with vasovagal manifestations occurring in 31% of tests.
  • Edrophonium induced vasovagal responses in 11%, while nitroglycerin caused responses in 50% (P < 0.001).

Conclusions:

  • A simplified HUT protocol with abbreviated fasting and tilted position medication administration is safe and effective.
  • Isoproterenol administration during HUT can potentially reduce overall testing time by avoiding rehydration and postural changes.
  • Nitroglycerin may lead to excessive responses in HUT, necessitating careful consideration.