Timing of first recurrence of syncope predicts syncopal frequency after a positive tilt table test result.
OBJECTIVE
This study sought to determine whether the time to first recurrence of syncope after a positive isoproteremol-tilt table test result accurately predicts the eventual frequency of syncope.


BACKGROUND
Both patient care and future clinical trials involving patients with neuromediated syncope will require a simple measure that reflects the frequency of syncope. The time from tilt table testing to the first recurrence of syncope might be such a measure.


METHODS
A cohort of 46 patients with syncope, in a university outpatient clinic, who had at least one syncopal spell after a positive isoproterenol-tilt table test result were followed up for up to 6.5 years (mean [+/-SD] 48 +/- 14 months). The time from tilt table testing to the first recurrence of syncope was correlated.


RESULTS
A total of 40 of 46 patients had more than one recurrent spell, with a median of eight recurrent spells. The time to the first syncopal spell predicted the frequency of spells with r = -0.79 (p < 0.001), whereas the time to the second spell predicted the frequency with r = -0.92 (p < 0.001). Patients who fainted within 1 month of tilt testing had a geometric mean frequency of 1.35 spells/month (95% confidence limits 0.49, 3.74) compared with patients who fainted 1 to 24 months after testing (0.12 spells/months; 95% confidence limits 0.07 to 0.18, p < 0.001). Finally, the frequency of syncopal spells bore no relation to the duration of follow-up.


CONCLUSIONS
The time to the first recurrent spell predicts the frequency of syncopal spells after a positive tilt table test result, and the instantaneous risk of syncope is constant.
Malik
P
P
Cardiovascular Research Group, University of Calgary, Alberta, Canada.
Koshman
M L
ML
Sheldon
R
R
D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007545:Isoproterenol; D016014:Linear Models; D008297:Male; D011237:Predictive Value of Tests; D012008:Recurrence; D012307:Risk Factors; D019462:Syncope, Vasovagal / Q000175:diagnosis / Q000453:epidemiology*; D018667:Tilt-Table Test; D013997:Time Factors
D007545:Isoproterenol