Document Detail

Implications of tilt-table induced faint time in patients with reflex syncope.
MedLine Citation:
PMID:  22037101     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The aim of this study was to determine whether patients who faint earlier in the course of a tilt table study represent a separate population with a poorer prognosis or different pathophysiology. We analyzed differences across patients with different syncopal times on the tilt-table study to answer this question.
METHODS: This was a retrospective, approved, chart review. From our database of over 6000 patients, we identified 1222 patients with syncope. After excluding patients with orthostatic hypotension, postural tachycardia syndrome and diabetes, we were left with 131 patients with pure reflex syncope. We divided fainters into an early (<20 minutes) and late (>20 minutes) faint times. Along with the tilt table test all patients underwent heart rate response for deep breathing, Valsalva maneuver and quantitative sudomotor axon reflex tests.
RESULTS: By 10 minutes in the tilt study, only 18% of subjects had fainted, 65% by 20 minutes, 92% by 30 minutes and 96% by 35 minutes. Age was evenly distributed across all syncopal times. Neither the 14 abnormal cardiac responses to deep breathing nor the 20 abnormal Valsalva maneuvers, nor the 28 abnormal axon reflex responses clustered with an early or late faint time.
CONCLUSION: A 10-minute tilt will miss 82% of syncopal episodes, while a 30- minute tilt increases the yield 10-fold, missing only 8%. Patients with early faint times did not differ from patients with late fainting times with regard to age or autonomic test abnormalities. Timing of syncope during the tilt table test does not associated with more severe dysautonomia. A prospective study is needed to confirm these observations.
Umit Hıdır Ulaş; Kevin McNeeley; Di Zhang; Gisela Chelimsky; Thomas Chelimsky
Publication Detail:
Type:  Journal Article     Date:  2011-10-28
Journal Detail:
Title:  Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology     Volume:  11     ISSN:  1308-0032     ISO Abbreviation:  Anadolu Kardiyol Derg     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-13     Completed Date:  2012-05-18     Revised Date:  2013-02-11    
Medline Journal Info:
Nlm Unique ID:  101095069     Medline TA:  Anadolu Kardiyol Derg     Country:  Turkey    
Other Details:
Languages:  eng     Pagination:  674-7     Citation Subset:  IM    
Neurological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA.
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MeSH Terms
Databases, Factual
Heart Rate
Middle Aged
Primary Dysautonomias / complications,  diagnosis,  physiopathology
Retrospective Studies
Syncope / complications,  physiopathology*
Tilt-Table Test*
Time Factors
Valsalva Maneuver
Young Adult
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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