Medtronic
 
 

Insertable
Cardiac Monitor

Interpreting Tilt Test Results in Syncope Diagnosis1

ISSUE Study: International Study of Syncope of Uncertain Etiology1

Results Tilt-Negative
Syncope (Isolated)
n=82		 Tilt-Positive
Syncope
n=29
Recurrent Event
Occurrence (#) 		34% (28) 34% (10)
Tachyarrhythmia 2% (2)  
Bradycardia 16% (13) 21% (6)
Sinus Brady 2% (2) 3% (1)
Sinus Arrest 12% (10) 17% (5)
AV Block 1% (1)  
Total Arrhythmic 18% (15) 21% (6)

  • Tilt (+) and tilt (-) patients have similar outcomes, recurrences, clinical characteristics, and etiology for syncope
  • Tilt (-) patients have symptomatic arrhythmias as often as tilt (+) patients (18% vs. 21%)
  • Bradyarrhythmias are more common during spontaneous symptoms than expected
  • Recurrence rates are the same for tilt (+) and tilt (-) patients (34%)

“This study clearly demonstrates that results of tilt table testing must be interpreted with considerable caution. There is nothing like recording the ECG during an actual clinical episode to provide confidence in the diagnosis.”

George J. Klein
Chair, Division of Cardiology
University of Western Ontario

Objective

Understand the cause of syncope in tilt (+) and tilt (-) patients using an insertable cardiac monitor (ICM) as a reference standard.

Methods

The ICM was implanted in 111 patients with syncope, a normal ECG and no significant structural heart disease. Patients had at least episodes of syncope in the previous 2 years.

References
  1. Moya A, Brignole M, Menozzi C, et al. Mechanism of syncope in patients with isolated syncope and in patients with tilt-positive syncope. Circulation. September 11, 2001;104(11):1261-1267.

 

Additional Information