Cited by 145Cardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic ControlVestibular and auditory disorders

Lack of correlation between the responses to tilt testing and adenosine triphosphate test and the mechanism of spontaneous neurally mediated syncope

Brignole, M.·2006·European Heart Journal

Abstract

AIMS: We prospectively correlated the results of tilt testing (TT) and adenosine triphosphate test (ATP) with the findings observed during a spontaneous syncopal relapse by means of an implantable loop recorder (ILR) in patients with a clinical diagnosis of neurally mediated syncope. METHODS AND RESULTS: We included patients with three or more clinically severe syncopal episodes in the last 2 years without significant electrocardiographic and cardiac abnormalities. Patients with orthostatic hypotension and carotid sinus syncope were excluded. After ILR implantation, patients were followed until the first documented syncope. Among 392 enrolled patients, 343 underwent TT, which was positive in 164 (48%), and 180 ATP test, which was positive in 53 (29%). Syncope was documented by ILR in 106 (26%) patients after a median of 3 months. Patients with positive and negative TT had similar baseline characteristics, syncopal recurrence rate, and mechanism of syncope, but those with positive TT had more frequently no or slight rhythm variations during spontaneous syncope (45 vs. 21%, P=0.02). An asystolic pause was more frequently found during spontaneous syncope than during TT (45 vs. 21%, P=0.02), but there was a trend for those with an asystolic response during TT also to have an asystolic response during spontaneous syncope (75 vs. 37%, P=0.1). Patients with positive ATP test responses showed syncopal recurrence rates and mechanism of syncope similar to those with negative ATP tests. CONCLUSION: In patients with neurally mediated syncope, clinical characteristics, outcome, and mechanism of syncope are poorly correlated and not predicted by the results of TT and ATP test. Therefore, these tests are of little or no value in guiding specific therapy.

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Crossref · 10.1093/eurheartj/ehl164

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  • A positive cardioinhibitory response to tilt testing predicts, with a high probability, an asystolic spontaneous syncope.

    “While a positive cardioinhibitory response to tilt testing predicts, with a high probability, an asystolic spontaneous syncope, the presence of a positive vasodepressor, mixed response, or even a negative response, does not exclude the presence of asystole during spontaneous syncope. 122,123”
  • The presence of a positive vasodepressor, mixed response, or even a negative response to tilt testing does not exclude the presence of asystole during spontaneous syncope.

    “While a positive cardioinhibitory response to tilt testing predicts, with a high probability, an asystolic spontaneous syncope, the presence of a positive vasodepressor, mixed response, or even a negative response, does not exclude the presence of asystole during spontaneous syncope. 122,123”
  • The presence of a positive vasodepressor, a mixed response, or even a negative response to tilt testing does not exclude the presence of asystole during spontaneous syncope.

    “Conversely, the presence of a positive vasodepressor, a mixed response, or even a negative response does not exclude the presence of asystole during spontaneous syncope. 122,123”
  • A positive cardioinhibitory response to tilt testing predicts, with high probability, asystolic spontaneous syncope.

    “A positive cardioinhibitory response to tilt testing predicts, with high probability, asystolic spontaneous syncope; this finding is relevant for therapeutic implications when cardiac pacing is considered (see section 5.2.6).”
  • Previous studies showed no correlation between AV block induced by ATP and ECG findings documented by ILR during spontaneous syncope.

    “previous studies showed no correlation between AV block induced by ATP and ECG findings (documented by ILR) during spontaneous syncope. 122,123,227”

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Authors
Brignole, M.
Affiliations
Presidio Ospedaliero (IT)
Corresponding author
Brignole, M.
Venue
European Heart Journal
Published
2006-08-09
Volume
27
Issue
18
Pages
2232-2239
ISSN
  • 0195-668X (ISSN-L)
  • 1522-9645
OpenAlex
W2128490123
Cited by
145
References
24
Citations by year
2026: 2 · 2025: 5 · 2024: 4 · 2023: 2 · 2022: 1 · 2021: 6 · 2020: 2 · 2019: 5 · 2018: 8 · 2017: 4 · 2016: 6 · 2015: 6 · 2014: 11 · 2013: 14 · 2012: 12
FWCI
11.12
Type
journal article
Language
en
Open access
closed
Locations
  • European Heart Journal (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
Keywords
neurally mediated syncope, tilt table test, implantable loop recorder, syncope mechanism, syncope recurrence, diagnostic test correlation, orthostatic hypotension
MeSH terms
Adenosine Triphosphate, Adult, Aged, Electrodes, Implanted, Female, Humans, Male, Middle Aged, Prospective Studies, Recurrence, Sensitivity and Specificity, Electrocardiography, Ambulatory, Tilt-Table Test, Syncope, Vasovagal

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