Related Experiment Video
Updated: Dec 9, 2025
Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance
Published on: March 21, 2013
Usefulness of post-procedural heart rate response to predict syncope recurrence or positive head up tilt table
Tolga Aksu1, Tumer Erdem Guler1, Serdar Bozyel1
1Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
Insights
Cardioneuroablation (CNA) effectively prevents recurrent vasovagal syncope (VVS) episodes and positive head-up tilt tests (HUT) in patients with refractory VVS. This procedure offers a durable solution for managing VVS.
Area of Science:
- Cardiology
- Electrophysiology
- Autonomic Nervous System Disorders
Background:
- Vasovagal syncope (VVS) is a common cause of syncope, often refractory to conventional treatments.
- Cardioneuroablation (CNA) has been proposed as a potential intervention for VVS.
- Previous reports suggest CNA may reduce syncopal recurrences.
Purpose of the Study:
- To assess the efficacy of CNA in preventing positive responses to head-up tilt testing (HUT).
- To evaluate the impact of CNA on syncopal recurrence in patients with VVS.
Main Methods:
- A single-centre retrospective study of 51 consecutive VVS patients with >3s asystole on HUT.
- Patients underwent CNA, followed by repeat HUT after 1 month.
- Outcomes included syncope recurrence and HUT response, with a median follow-up of 11 months.
Main Results:
- 5.8% of patients experienced syncope recurrence during follow-up.
- 86.2% of patients had negative repeat HUT results.
- CNA demonstrated significant, durable RR interval shortening, particularly in patients with negative HUT responses.
Conclusions:
- CNA is effective in preventing recurrent syncopal episodes in refractory VVS patients.
- HUT is a valuable tool for selecting candidates and evaluating CNA success.
- CNA offers a promising therapeutic option for managing VVS.
Aims:
Previous reports have suggested that cardioneuroablation (CNA) can be effective in reducing syncopal recurrences in patients with vasovagal syncope (VVS). This study assessed the efficacy of CNA in preventing a positive response to head-up tilt testing (HUT).
Methods And Results:
This is a single-centre retrospective study reviewing prospectively collected data. Fifty-one consecutive patients with VVS were included in the study. After confirmation of >3 s asystole on HUT, all patients underwent CNA. Head-up tilt testing was repeated 1 month after CNA. The main outcome measures were recurrence of syncope episode and positive response on HUT. During a median follow-up period of 11 months (interquartile range 3-27 months), all but 3 (5.8%) of 51 patients were free of syncope. Repeated HUTs were negative in 44 (86.2%) patients. When patients with recurrent syncope were excluded, vasodepressor response was seen in three cases and cardioinhibitory response in one case, respectively. Cardioneuroablation caused significant and durable shortening of RR interval in all cases. This effect was significantly higher in patients without positive HUT responses.
Conclusion:
This pilot study shows that CNA can effectively prevent recurrent syncopal episodes in patients with refractory VVS. Head-up tilt testing seems as a valuable diagnostic tool not only to select suitable candidates and but also to evaluate success of CNA.
