title: Holter monitoring vs tilt testing in the investigation of suspected vasovagal syncope.
abstract: The aim of this study was to compare the diagnostic yield of 48-hour Holter monitoring with head-up tilt (HUT) test in patients presenting with blackouts suggestive of vasovagal syncope. One hundred and eighteen consecutive patients, 68 women, aged (mean [SD])50 +/- 20 years(range 16-88 years), underwent 48-hour Holter monitoring and 60 degrees HUT test within 3 months. Endpoints were symptom-ECG correlation during Holter monitoring and positive HUT test. Syncope occurred in 3 (3%) patients during Holter monitoring, the rhythm being sinus tachycardia in all. Presyncope was reported in 22 (19%), the rhythm being sinus tachycardia in 6, persistent atrial fibrillation in 2, and normal sinus rhythm in the remainder. Asymptomatic arrhythmias were recorded in 103 (87%) patients. Positive HUT tests occurred in 39 (33%), the pattern being mixed (VASIS type 1) in 14 (36%), cardioinhibitory (VASIS type 2) in 3 (8%), and vasodepressor (VASIS type 3) in 22 (56%). Change in patient management occurred in 3 (3%) patients following Holter monitoring and 39 (33%) patients following HUT test. Holter monitoring produces a low yield of clinically useful information in the investigation of suspected vasovagal syncope. An HUT test should be considered the primary investigation of choice in such patients.
authors.affiliation: Department of Cardiology, Hope Hospital, Salford, United Kingdom. alan.fichet@srht.nhs.uk
authors.forename: Alan
authors.initials: A
authors.lastname: Fitchet
authors.forename: Marlene
authors.initials: M
authors.lastname: Stirling
authors.forename: Gill
authors.initials: G
authors.lastname: Burnett
authors.forename: Graham K
authors.initials: GK
authors.lastname: Goode
authors.forename: Clifford J
authors.initials: CJ
authors.lastname: Garratt
authors.forename: Adam P
authors.initials: AP
authors.lastname: Fitzpatrick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019462:Syncope, Vasovagal / Q000175:diagnosis* / Q000503:physiopathology; D018667:Tilt-Table Test