Recurrent unexplained syncope in the elderly: the use of head-upright tilt table testing in evaluation and management.
OBJECTIVE
To investigate the usefulness of head-upright tilt table testing for vasovagal episodes in the evaluation and management of elderly patients with recurrent idiopathic syncope.


METHODS
Prospective survey.


METHODS
Electrophysiology laboratory of a university hospital.


METHODS
Twenty-five patients (11 male, 14 female; mean age 73 +/- 6 years) with recurrent unexplained syncope and seven control subjects with other causes of syncope (4 male, 3 female; mean age 70 +/- 4 years).


METHODS
Each patient underwent head-upright tilt table testing for 30 minutes with or without an infusion of isoproterenol (1-3 micrograms/min given intravenously) in an attempt to provoke bradycardia, hypotension, or both.


RESULTS
Syncope occurred in nine patients (36%) during the baseline tilt and in seven patients (28%) during isoproterenol infusion (total positives 64%). None of the controls had syncope during the test. All of the patients who had positive test results eventually became tilt table negative with therapy, and over a mean follow-up period of 24 months, no further syncopal episodes have occurred.


CONCLUSIONS
Head-upright tilt table testing combined with isoproterenol infusion may be a useful tool in the diagnosis of vasovagal syncope in the elderly and in the evaluation of preventive therapy.
Grubb
B P
BP
Department of Medicine, Medical College of Ohio, Toledo 43699.
Wolfe
D
D
Samoil
D
D
Madu
E
E
Temesy-Armos
P
P
Hahn
H
H
Elliott
L
L
D000368:Aged; D000369:Aged, 80 and over; D001262:Atenolol / Q000008:administration & dosage / Q000627:therapeutic use; D001513:Beds / Q000592:standards*; D001794:Blood Pressure; D004206:Disopyramide / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D006257:Head; D006801:Humans; D007545:Isoproterenol / Q000008:administration & dosage; D008297:Male; D008991:Monitoring, Physiologic; D011187:Posture; D011446:Prospective Studies; D012008:Recurrence; D012601:Scopolamine / Q000008:administration & dosage / Q000627:therapeutic use; D013575:Syncope / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology
D001262:Atenolol; D012601:Scopolamine; D004206:Disopyramide; D007545:Isoproterenol