Europace (2001) 3, 136–140 doi:10.1053/eupc.2001.0153, available online at http://www.idealibrary.com on
SYNCOPE
Age and gender differences in basal and isoprenaline protocols for head-up tilt table testing G. Baro´n-Esquivias1, A. Pedrote1, A. Cayuela2, J. I. Valle1, J. M. Ferna´ndez1, M. J. Estepa1, E. Martı´nez-Morentı´n1, M. Navarro1 and J. Burgos1 1
Cardiology Department and 2Supportive Unit for Research, Hospital Universitario Virgen del Rocı´o, Avenida de Manuel Siurot s/n, 41013 Seville, Spain
Aims Syncope is a common occurrence, the prevalence of which increases with age, and among the multiple causes of syncope, neurally mediated syncope is thought to be a frequent cause in the young and in the elderly. Head-up tilt table testing (HUT) has become the diagnostic test of choice for neurally mediated syncope, the response to which varies clearly with age. The purpose of this study is to report the differences among patients suffering syncope referred for HUT, and the influence of age and gender on HUT results (percentage of positive responses and response patterns) in two study protocols (basal and isoprenaline). Methods and Results One thousand, two hundred and nineteen patients with syncope were referred to the authors’ Cardiology Department for HUT from September 1990 to April 2000; 1061 undergoing basal HUT (Group A) and 158 undergoing isoprenaline tilt table testing (Group B). Complications were noted in neither protocol. Females were more frequent among young people, and males in the
Introduction Syncope, a common occurrence in the general population[1], is often unexplained or attributed to vasovagal reactions. Following Kenny et al.’s[2] decisive article in 1986, head-up tilt table testing (HUT) has become a widely employed technique in the study of syncope of unknown origin, and has emerged as a means of identifying patients with a predisposition to neurally mediated syncope[3]. It has been traditionally accepted that classical vasovagal neurally mediated syncope (diagnosis Manuscript submitted 5 July 2000, and accepted 23 January 2001. Correspondence: G. Baro´n-Esquivias, MD, Avenida de Portugal, 19. 3 Izda, 41004-Seville, Spain. E-mail:
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elderly (P40 bpm) or brief asystole was observed. Cardioinhibitory (type II) response was defined as a marked bradycardia (10 s) or prolonged asystole (>3 s) occurring at the same time as syncope. Hypotensive (type III) response was defined when isolated hypotension was observed during syncope[25]. This paper uses the term ‘other responses’ to refer to those abnormal but not classical vasovagal or neurally mediated responses during HUT. The positive rate of HUT was defined as the proportion of patients with unexplained syncope who had a positive (or abnormal) test result with reproduction of spontaneous syncope.
Statistical analysis Data were collected consecutively, and analysed retrospectively. Continuous variables were expressed as median (interquartile range) if their distribution was not normal, and such medians were compared between subjects with positive HUT and those with negative HUT by Mann–Whitney’s test. Kruskall–Wallis’ test was used when comparing by age groups. Age relation to HUT outcome was determined by comparing positive and negative results in four pre-defined age groups with 2 analysis. A two-tailed P value
