engleski

Role of tilt-table test in differential diagnosis of unexplained syncope

The aim of this retrospective study (February 2012 - September 2014) was to investigate the role of head-up tilt-testing in patients with unexplained syncope. It was performed on 235 patients at Department of Cardiology, University Hospital “Sestre milosrdnice”. They were classified according to the test indications: Group A (convulsive syncope, n=30), Group B (suspected vasovagal syncope, n=180) and Group C (paroxysmal vertigo, n=25). The groups were analysed and compared by their demographic data (age, gender), referral specialists (cardiologists, neurologists, others) and test results (positive/negative) with specific response (cardioinhibitory, vasodepressor, or mixed). Groups A and B were referred most frequently by neurologists and cardiologists (p<0.05). The test was positive in 34 (14.5%) of all evaluated patients (5 in Group A and 29 in Group B), of which 13 (38.2%) had cardioinhibitory, 11 (32.4%) mixed and 10 (29.4%) vasodepressor response. In cardioinhibitory subgroup, 3 patients (23.1%, 2 males/1 female, mean age 28.5 years) with normal electroencephalography were on antiepileptics. During head-up tilt-testing, they had typical convulsions with cardioinhibition and bradycardia (heart rate 30.0±5.0 beats/min) followed by asystole (13.7±11.0 seconds). These three subjects got a permanent pacemaker (atrial/ventricular stimulation, heart rate control) and anticonvulsive therapy was slowly withdrawn with no syncope recurrence during 24 months of follow-up. In conclusion, head-up tilt-test has an important role in evaluation of the patients with unexplained syncope and in differential diagnosis of vasovagal syncope. Indication for a pacemaker implantation, strictly following the European Society of Cardiology guidelines, proved to be effective in preventing syncope relapses in patients with cardioinhibitory convulsive snycope.

cardioinhibitory syncope; seizures; tilt-up table-test; permanent pacemaker; epilepsy.

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