title: Safety and tolerability of Tilt Testing and Carotid Sinus Massage in the octogenarians.
abstract: OBJECTIVE
  to evaluate the safety and tolerability of Tilt Testing (TT) and Carotid Sinus Massage (CSM) in octogenarians with unexplained syncope.
  
  
  METHODS
  patients consecutively referred for transient loss of consciousness to the 'Syncope Units' of three hospitals were enrolled. TT and CSM were performed according to the European Society of Cardiology guidelines on syncope. Complications were evaluated in each group. An early interruption of TT was defined as 'intolerance' and considered as a non-diagnostic response.
  
  
  RESULTS
  one thousand four hundred and one patients were enrolled (mean age 72 ± 16 years, male 40.8%). Six hundred and ninety-four patients (49.5%) were 80 years old or older (mean age 83 ± 3 years) and 707 (50.5%) were younger (mean age 60 ± 17 years). Complications after TT occurred in 4.5% of older patients and in 2.1% of the younger ones (P = 0.01). All complications were 'minor/moderate', as prolonged hypotension, observed in ∼3% of patients ≥80 years. Major complications such as sustained ventricular tachycardia, ventricular fibrillation, asystole requiring cardiac massage, transient ischaemic attack, stroke and death were not observed in any patient. The presence of orthostatic hypotension and the mean number of syncopal episodes were predictors of TT complications. Intolerance was reported in 2.4% of older patients and 1% of the younger ones (P = 0.08), mainly due to orthostatic intolerance. No complications occurred after CSM.
  
  
  CONCLUSIONS
  TT and CSM appear to be safe and well tolerated in octogenarians, who should not be excluded by age from the diagnostic work-up of syncope.
authors.affiliation: Geriatric Cardiology and Medicine, University of Florence and Careggi Hospital, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ungar
authors.affiliation: Geriatric Cardiology and Medicine, University of Florence and Careggi Hospital, Florence, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Rivasi
authors.affiliation: Geriatric Cardiology and Medicine, University of Florence and Careggi Hospital, Florence, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Rafanelli
authors.affiliation: Geriatric Cardiology and Medicine, University of Florence and Careggi Hospital, Florence, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Toffanello
authors.affiliation: Geriatric and Gerontology Institute, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Mussi
authors.affiliation: Geriatric Cardiology and Medicine, University of Florence and Careggi Hospital, Florence, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Ceccofiglio
authors.affiliation: Department of Neurology, Trinity College, Dublin, Ireland.
authors.forename: Ruth
authors.initials: R
authors.lastname: McDonagh
authors.affiliation: School of Medicine and Institute of Neuroscience, Trinity College, St James's Hospital, Dublin, Ireland.
authors.forename: Breffni
authors.initials: B
authors.lastname: Drumm
authors.affiliation: Geriatric Cardiology and Medicine, University of Florence and Careggi Hospital, Florence, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.affiliation: Section of Cardiology and Syncope Unit, Ospedale Privato Quisisana, Ferrara, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Alboni
authors.affiliation: School of Medicine and Institute of Neuroscience, Trinity College, St James's Hospital, Dublin, Ireland.
authors.forename: Rose Anne
authors.initials: RA
authors.lastname: Kenny
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002346:Carotid Sinus / Q000503:physiopathology*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006302:Health Services Research; D006299:Health Services for the Aged; D006801:Humans; D007494:Ireland; D007558:Italy; D008297:Male; D008405:Massage / Q000009:adverse effects; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013575:Syncope / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D018667:Tilt-Table Test / Q000009:adverse effects
keywords: Carotid sinus syncope; Safety; Tilt Table Test; octogenarian; older people