[Head-up tilt table test in patients with syncope of unexplained origin]

Area of Science:

• Cardiology
• Neurology
• Clinical Medicine

Context:

• Syncope of unexplained origin affects a significant patient population.
• Accurate diagnosis is crucial for effective management and prevention of recurrent syncopal episodes.
• The head-up tilt test (TT) is a diagnostic tool used to evaluate patients with syncope.

Purpose:

• To evaluate the utility of the head-up tilt test in diagnosing syncope of unknown origin.
• To assess the role of a second tilt test after atropine administration in differentiating vasovagal syndrome subtypes.
• To determine the impact of diagnostic findings on treatment strategies and patient outcomes.

Summary:

• Forty-one patients with unexplained syncope underwent a 60-degree head-up tilt test (TT) with continuous ECG and arterial blood pressure monitoring.
• Syncope was induced in 46% of patients during the initial TT. A second TT with atropine administration helped differentiate between cardioinhibitory, mixed, and vasodepressor forms of vasovagal syndrome.
• Treatment included pacemaker implantation, clonidine, propranolol, or atropine derivatives. A one-year follow-up showed 14 patients were syncope-free and 5 experienced rare recurrences.

Impact:

• The head-up tilt test is highly valuable for diagnosing the cause of syncope.
• Utilizing a second tilt test with atropine aids in classifying vasovagal syndrome, leading to more targeted and effective patient treatment.
• This diagnostic approach can improve syncope management and patient quality of life.