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Atrioventricular block during upright tilt table test.

Gabriel Vanerio¹, Ana Vanerio de León, Juan Luis Vidal Amaral

¹Arrhythmia Service CASMU-INCC, Montevideo, Uruguay. gabvaner@mednet.org.uy

Pacing and Clinical Electrophysiology : PACE

|May 6, 2004

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Atrioventricular block during upright tilt table tests is rare, primarily affecting young women and showing good long-term prognosis, similar to asystole. Pacemaker implantation is generally not indicated for AVB in these patients.

Area of Science:

Cardiology
Neuroscience

Background:

Cardioinhibitory responses during upright tilt table testing (UTT), including asystole and atrioventricular block (AVB), present therapeutic challenges.
Current understanding of AVB during UTT and its comparison to asystole, especially regarding pacemaker indications, is limited.

Purpose of the Study:

To investigate patients with cardioinhibitory responses during UTT, focusing on the incidence of AVB versus asystole.
To compare the outcomes of patients experiencing AVB and asystole during UTT during prolonged follow-up.

Main Methods:

Retrospective analysis of 867 patients undergoing UTT.
Comparison of demographic and clinical characteristics between patients with AVB (Group A) and asystole (Group B).
Assessment of medium- to long-term outcomes, including syncope recurrence and pacemaker implantation.

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Main Results:

Of 172 patients with neurally mediated responses, 6 (3.4%) developed AVB (Group A) and 26 (15.1%) experienced asystole (Group B).
Group A predominantly comprised young women (100%) with sinus rate deceleration during AVB. Group B had a higher male representation (62%) and longer pauses.
Follow-up revealed syncope recurrences in 7 patients in Group B and 1 in Group A. One patient in Group B received a pacemaker; no deaths occurred.

Conclusions:

Atrioventricular block during UTT is an infrequent finding, typically observed in young women and consistently associated with sinus rate deceleration.
The long-term prognosis for patients with AVB during UTT is favorable and comparable to that of patients with asystole.
There is currently no evidence to support the routine need for pacemaker implantation in patients diagnosed with AVB during UTT.