Tilt table testing in the diagnosis of unexplained syncope

QJM: An International Journal of Medicine

Volumn 92, Issue 11, 1999, Pages 623-629

  Parry, S W ^a   Kenny, R A ^a  

^a ROYAL VICTORIA INFIRMARY   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

CATECHOLAMINE; ISOPRENALINE; NITRATE;

DIFFERENTIAL DIAGNOSIS; HUMAN; METHODOLOGY; PATHOPHYSIOLOGY; PRIORITY JOURNAL; REVIEW; SYNCOPE; TILT TABLE TEST;

EID: 0032750873     PISSN: 00335622     EISSN: None     Source Type: Journal    
DOI: 10.1093/qjmed/92.11.623     Document Type: Review

References (73)

1. Allen SC, Taylor CL, Hall VE. A study of orthostatic insufficiency by the tiltboard method. Am J Physiol 1945; 143:11.
2. Kenny RA, Ingram A, Bayliss J, Sutton R. Head-up tilt: a useful test for investigating unexplained syncope. Lancet 1986; 1:1352-4.
3. Benditt DG, Ferguson DW, Grubb BP, Kapoor WN, Kugler J, Lerman BB, et al. Tilt table testing for assessing syncope. ACC Expert Consensus Document. J Am Coll Cardiol 1996; 28:263-75.
4. Lewis T. Vasovagal syncope and the carotid sinus mechanism. With comments on Gower's and Nothnagels syndrome. Br Med J 1932; 1:873-6.
5. Parry SW, Kenny RA. Tilt table testing. In: Malik M, ed. Clinical Guide to Cardiac Autonomic Tests. Amsterdam, Kluwer Academic Publishers, 1998:67-99.
6. Greenfield ADM. An emotional faint. Lancet 1951; 1:1302-3.
7. Weiling W, Smit AAJ, De Jong-De Vos Van Steenwijk CCE, Van Lieshout JJ, Karemaker JM. Pathophysiological mechanisms underlying vasovagal syncope in young subjects. Pacing Clin Electrophysiol 1997; 20:2034-8.
8. Koizumi K, Kollai M. Control of reciprocal and non-reciprocal action of vagal and sympathetic efferents: study of centrally induced reactions. J Auton Nerv Syst 1981; 3:483-501.
9. Le Doux JE. Emotion and the amygdala. In: Aggleton JP, ed. The Amygdala: Neurobiological Aspects of Emotion, Memory, and Mental Dysfunction, New York, Wiley-Liss, 1992:339-51.
10. Mark AL. The Bezold-Jarisch reflex revisited: clinical implications of inhibitory reflexes originating in the heart. J Am Coll Cardiol 1983; 1:90-102.
11. Coleridge HM, Coleridge JCG, Kidd C. Cardiac receptors in the dog, with reference to two types of afferent endings in the ventricular wall. J Physiol (Lond) 1964; 174:323-9.
12. Epstein SE, Stampfer M, Beiser GD. Role of the capacitance and resistance vessels in vasovagal syncope. Circulation 1968; 37:524-33.
13. Kaufman H. Neurally mediated syncope and syncope due to autonomic failure: differences and similarities. J Clin Neurophysiol 1997; 14:183-96.
14. Oberg B, Thoren P. Increased activity in left ventricular receptors during haemorrhage or occlusion of caval veins in the cat. A possible cause of the vasovagal reaction. Acta Physiol Scand 1972; 85:164-73.
15. Shalev Y, Gal R, Tchou PJ, Anderson AJ, Avitall B, Akhtar M, et al. Echocardiographic demonstration of decreased left ventricular dimensions and vigorous myocardial contraction during syncope induced by head-up tilt. J Am Coll Cardiol 1991; 18:746-51.
16. Seller H. Central baroreceptor reflex pathways. In: Persson PB, Kircheim HR, eds. Baroreceptor Reflexes. Berlin, Springer Verlag, 1991:45-74.
17. Fitzpatrick A, Williams T, Ahmed R, Lightman S, Bloom SR, Sutton R. Echocardiographic and endocrine changes during vasovagal syncope induced by prolonged head-up tilt. Eur J Cardiac Pacing Electrophysiol 1992; 2:121-8.
18. Scherrer U, Vissing S, Morgan BJ, Hanson P, Victor RG. Vasovagal syncope after infusion of a vasodilator in a heart transplant recipient. N Engl J Med 1990; 322:602-4.
19. Hainsworth R, al Shamma YMH. Cardiovascular responses to upright tilting in healthy subjects. Clin Sci 1988; 74:17-22.
20. Sneddon JF, Counihan PJ, Bashir Y, Haywood GA, Ward DE, Camm AJ. Impaired immediate vasoconstrictor responses in patients with recurrent neurally mediated syncope. Am J Cardiol 1993; 71:72-6.
21. Grubb BP, Samoil D. Neurocardiogenic syncope. In: Kenny RA, ed. Syncope in the Older Patient: Causes, Investigations and Consequences of Syncope and Falls. London, Chapman & Hall, 1996:91-106.
22. Sra JS, Murthy V, Natale A, Jazayeri MR, Dhala A, Deshpaned S, et al. Circulatory and catecholamine changes during head-up tilt testing in neurocardiogenic (vasovagal) syncope. Am J Cardiol 1994; 73:33-7.
23. Jellema WT, Imholz BPM, Van Goudoever J, Wesseling KH, Van Lieshout J. Finger arterial versus intrabrachial pressure and continuous cardiac output during head-up tilt testing in healthy subjects. Clin Sci 1996; 91:193-200.
24. Victor J. Tilt Test: environment, material, patient preparation. In: Blanc JJ, Benditt D, Sutton R, eds. Neurally Mediated Syncope: Pathophysiology, Investigations, and Treatment. The Bakken Research Center Series Vol. 10. Armonk, NY, Futura, 1996:77-8.
25. McIntosh SJ, Lawson J, Kenny RA. Intravenous cannulation alters the specificity of head-up tilt testing for vasovagal syncope in elderly patients. Age Ageing 1994; 23:317-19.
26. Stevens PM. Cardiovascular dynamics during orthostasis and the influence of intravascular instrumentation. Am J Cardiol 1966; 17:211-18.
27. Blanc J, Victor J, Mansourati J, Le Davay M, Dupuis J-M, Maheu B. Accuracy and mean duration of different protocols of head-up tilt testing. Am J Cardiol 1996; 77:310-13.
28. Fitzpatrick AP, Theodorakis C, Vardas P, Sutton R. Methodology of head upright tilt table testing in patients with unexplained syncope. J Am Coll Cardiol 1991; 17:125-30.
29. Fitzpatrick AP, Theodorakis G, Vardas P, Sutton R. Methodology of head upright tilt table testing in patients with unexplained syncope. J Am Coll Cardiol 1991; 17:125-30.
30. Fitzpatrick A, Sutton R. Tilting towards a diagnosis in recurrent unexplained syncope. Lancet 1989; 1:658-70.
31. McIntosh S, Lawson J, da Costa D, Kenny RA. Use of sublingual glyceryl trinitrate during head-up tilt as a provocative test for vasovagal responses in elderly patients with unexplained syncope. Cardiol Elderly 1996; 4:33-7.
32. Almquist A, Goldenberg IF, Milstein S, Chen M-Y, Chen X, Hansen R, et al. Provocation of bradycardia and hypotension by isoprolerenol and upright posture in patients with unexplained syncope. N Engl JMed 1989; 320:346-51.
33. Benditt DG. Neurally mediated syncopal syndromes: pathophysiological concepts and clinical evaluation. Pacing Clin Electrophysiol 1997; 20:572-84.
34. Fouad FM, Sitthisook S, Vanerio G, Maloney J, Okabe M, Jaeger F, et al. Sensitivity and specificity of the tilt table test in young patients with unexplained syncope. Pacing Clin Electrophysiol 1993; 16:394-400.
35. Raviele A, Gasparini G, DiPede F, Delise P, Bonso A, Piccolo E. Usefulness of head-up tilt test in evaluating patients with syncope of unknown origin and negative electrophysiologic study. Am J Cardiol 1990; 65:1322-7.
36. Petersen MEV, Price D, Williams T, Jensen N, Riff K, Sutton R. Short AV interval VDD pacing does not prevent tilt induced vasovagal syncope in patients with cardioinhibitory vasovagal syndrome. Pacing Clin Electrophysiol 1994; 17:882-91.
37. Blanc JJ, Mansourati J, Maheu B, Boughaleb D, Genet L. Reproducibility of a positive passive upright tilt test at a seven-day interval in patients with syncope. Am J Cardiol 1993; 72:469-71.
38. Sheldon R, Splawinski J, Killam S. Reproducibility of upright tilt-table tests in patients with syncope. Am J Cardiol 1992; 69:1300-5.
39. Brooks R, Ruskin JN, Powell AC, Newell J, Garan H, McGovern BA. Prospective evaluation of day-to-day reproducibility of upright tilt-table testing in unexplained syncope. Am J Cardiol 1993; 72:1289-92.
40. Fish FA, Strasburger JF, Woodrow Benson D. Reproducibility of a symptomatic response to upright tilt in young patients with unexplained syncope. Am J Cardiol 1992; 70:605-9.
41. Chen XC, Chen MY, Remole S, Kobayashi Y, Dunnigan A, Milstein S, et al. Reproducibility of head-up tilt-table testing for eliciting susceptibility to neurally mediated syncope in patients without structural heart disease. Am J Cardiol. 1992; 69:755-60.
42. De May C, Enterling D. Variant responses impair the usefulness of passive upright tilt in drug research. Methods Find Exp Clin Pharmacol 1988; 10:57-64.
43. Morillo CA, Klein CJ, Zandri S, Yee R. Diagnostic accuracy of a low dose isoproterenol head-up tilt protocol. Am Heart 1995; 129:901-6.
44. Davies R, Slater JDH, Forsling ML. The response of arginine vasopressin and plasma renin to postural change in normal man, with observations on syncope. Clin Sci 1976; 51:267-74.
45. Carlioz R, Graux P, Haye J, Letourneau T, Guyomar Y, Hubert E, et al. Prospective evaluation of high dose and low dose isoproterenol upright tilt protocol for unexplained syncope in young adults. Am Heart J 1997; 133:346-52.
46. Waxman MB, Yao L, Cameron D, Wald RW, Roseman J. Isoproterenol induction of vasodepressor-type reaction in vasodepressor-prone persons. Am J Cardiol 1989; 63:58-65.
47. Fitzpatrick AP, Lee RJ, Epstein LM, Lesh MD, Eisenberg S, Scheinman MM. Effect of patient characteristics on the yield of prolonged baseline head-up tilt testing and the additional yield of drug provocation. Heart 1996; 76:406-11.
48. Graham L, Kenny RA. Comparison of intravenous isoprenaline and sublingual glyceryl trinitrate for provocation of vasovagal syncope during tilt table testing -a randomised controlled trial. Pacing Clin Electrophysiol 1998; 21 (4 part II):793, A14.
49. Raviele A, Gasparini G, Di Pede F, Menozzi C, Brignole M, Dinelli M, et al. Nitroglycerine infusion during upright tilt: a new test for the diagnosis of vasovagal syncope. Am Heart J 1994; 127:103-11.
50. Ammirati F, Colvicchi F, Biffi A, Magris B, Pandozi C, Santini M. Head-up tilt testing potentiated with low-dose sublingual isosorbide dinitrate: A simplified time-saving approach for the evaluation of unexplained syncope. Am Heart J 1998; 135:671-6.
51. Raviele A, Menozzi C, Brignole M, Gasparini G, Alboni P, Musso G, et al. Value of head-up tilt testing potentiated with sublingual nitroglycerine to assess the origin of unexplained syncope. Am J Cardiol 1995; 76:267-72.
52. Aerts A, Dendale P, Strobel C, Block P. Sublingual nitrates during head-up tilt testing for the diagnosis of vasovagal syncope. Am Heart J 1997; 133:504-7.
53. Biaggioni I, Killian TJ, Mosqueda-Garcia R, Robertson RM, Robertson D. Adenosine increases sympathetic nerve traffic in humans. Circulation 1991; 83:1668-75.
54. Tseng C-G, Biaggioni B, Appalsamy M, Robertson D. Purinergic receptors in the brainstem mediate hypotension and bradycardia. Hypertension 1988; 11:191-7.
55. Shen W-K, Hammill SC, Munger TM, Stanton MS, Packer DL, Osborn MJ, et al. Adenosine: potential modulator for vasovagal syncope. J Am Coll Cardiol 1996; 28:146-54.
56. Lurie KG, Dutton J, Mangat R, Newman D, Eisenberg S, Scheinman M. Evaluation of edrophonium as a provocative agent for vasovagal syncope during head-up tilt-table testing. Am J Cardiol 1993; 72:1286-90.
57. Flevari P, Theodorakis GN, Zarvaliss E, Livanis E, Mesiskli T, Kremastinos DT. Head-up tilt test after clomipramine challenge in neurally mediated syncope patients. Pacing Clin Electrophysiol 1998; 21 (4 part II):793, A13.
58. Sutton R, Petersen M, Brignole M, Raviele A, Menozzi C, Giani P. Proposed classification for tilt induced vasovagal syncope. Eur J Cardiac Pacing Electmphysiol 1992; 3:180-3.
59. Grubb BP, Orecchio E, Kurczynski TW. Head-upright tilt table testing in evaluation of recurrent unexplained syncope. Paediatr Neurol 1992; 8:423-7.
60. Thilenius OG, Quinones JA, Huusayni TS, Novak J. Tilt test for diagnosis of unexplained syncope in paediatric patients. Pediatrics 1991; 87:334-8.
61. Lerman-Sagie T, Rechavia E, Strasberg B, Sagie A, Blieden L, Mimouni M. Head-up tilt for the evaluation of syncope of unknown origin in children. J Pediatr 1991; 118:676-9.
62. Lipsitz LA, Marks ER, Koestner J, Jonsson PV, Wei JY. Reduced susceptibility to syncope during postural tilt in old age. Is beta-blockade protective? Arch Intern Med 1989; 149:2709-12.
63. Sutton R. Vasovagal syncope: clinical features, epidemiology and natural history. In: Blanc JJ, Benditt D, Sutton R, eds. Neurally Mediated Syncope. Pathophysiology, Investigations, and Treatment. The Bakken Research Center Series Vol. 10 Armonk NY, Futura, 1996:71-6.
64. Petersen MEV, Williams TR, Sutton R. Psychogenic syncope diagnosed by prolonged head-up tilt testing. Q J Med 1995; 88:209-13.
65. Naschitz JE, Gaitini L, Mazov L, Eridzhanyan D, Keren E, Sabo D, Yeshurun D, Hardoff D, Jaffe M. The capnography-tilt test for the diagnosis of hyperventilation syncope. Q J Med 1997; 90:139-45.
66. Grubb BP, Kosinski DJ, Boehm K, Kip K. The postural orthostatic tachycardia syndrome. A neurocardiogenic variant identified during head-up tilt table testing. Pacing Clin Electrophysiol 1997; 20:2205-12.
67. Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. J Neurol Sci 1996; 144:218-19.
68. Grubb BP, Ferard G, Roush K, Temesy-Armos P, Elliott L, Hahn H, et al. Differentiation of convulsive syncope and epilepsy with head-up tilt table testing. Ann Intern Med 1991; 115:871-6.
69. Zaidi A, Clough P, Scheepers B, Fitzpatrick A. Treatment resistant epilepsy or convulsive syncope. Br Med J 1998; 317:869-70.
70. Kenny RA, McIntosh SJ. Carotid sinus syndrome. In: Kenny RA, ed. Syncope in the Older Patient: Causes, Investigations and Consequences of Syncope and Falls. London, Chapman & Hall, 1996:107-22.
71. Hammill SC, Holmes DR, Wood DL. Electrophysiologic testing in the upright position: improved evaluation of patients with rhythm disturbance using a tilt table. J Am Coll Cardiol 1984; 4:65-71.
72. McIntosh SJ, Lawson J, Kenny RA. Clinical characteristics of vasodepressor, cardioinhibitory and mixed carotid sinus syndrome in the elderly. Am J Med 1993; 95:203-8.
73. Parry SW, Richardson DA, O'Shea D, Kenny RA. Diagnosing carotid sinus hypersensitivity: carotid sinus massage upright is essential. Pacing Clin Electrophysiol 1998; 21:805, A62.