title: [Long-term prognosis of patients with syncope of unknown origin in prolonged asystole induced by the head-up tilt test].
abstract: OBJECTIVE
  Prognosis and therapeutic assessment of patients with syncope and prolonged asystole during head-up tilt test remain unclear. The aim of the present study was to analyze the clinical evolution of patients with syncope of unknown origin, no heart disease and severe cardioinhibitory response induced by head-up tilt.
  
  
  METHODS
  A prospective follow-up study was performed in 12 patients (6 male and 6 female, mean age 31 +/- 20 years) with recurrent syncope, no heart disease and affected by severe cardioinhibitory syncope induced by head-up tilt test. This was defined as syncope or near-syncope induced by baseline or isoproterenol tilt with asystole of > or = 3 seconds. All patients were re-tilted twice: with salt and fluid and with metoprolol (25 mg/b.i.d). According to the results of these tests, 5 patients were discharged with dietetic measures (salt & fluid) and 5 with metoprolol. In 2 patients who showed recurrent prolonged asystole a DDD pacemaker was implanted.
  
  
  RESULTS
  After follow-up of 34 +/- 20 months all patients ae alive. The number of recurrences was small (2 syncopes and 2 near-syncopes). No relationship was observed between the number of syncopal recurrences and the applied treatment.
  
  
  CONCLUSIONS
  We conclude that prolonged asystole induced by head-up tilt test does not confer an adverse prognosis in patients with syncope of unknown origin and no heart disease, thus, the clinical evolution of these patients is benign.
authors.affiliation: Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Murcia.
authors.forename: M
authors.initials: M
authors.lastname: Pérez-Paredes
authors.forename: F
authors.initials: F
authors.lastname: Picó Aracil
authors.forename: J G
authors.initials: JG
authors.lastname: Sánchez Villanueva
authors.forename: R
authors.initials: R
authors.lastname: Florencianó Sánchez
authors.forename: E
authors.initials: E
authors.lastname: Expósito Ordóñez
authors.forename: M
authors.initials: M
authors.lastname: Gonzálvez Ortega
authors.forename: E
authors.initials: E
authors.lastname: González Caballero
authors.forename: M D
authors.initials: MD
authors.lastname: Espinosa García
authors.forename: L
authors.initials: L
authors.lastname: Iñigo García
authors.forename: J A
authors.initials: JA
authors.lastname: Ruipérez Abizanda
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011187:Posture / Q000502:physiology; D011379:Prognosis; D013575:Syncope / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy