Serious Response During Tilt-table Test In Elderly And Its Prophylactic Management

Objective and backgroud:Tilt-table test (TTT) has been widely accepted as one of the main measures for diagnosing vasovagal syncope (VVS), with 30%-90% positive rate and above 90% specificity. Although non-invasive, TTT may have risks, especially to the elders or in isoproterenol-provocative test. Even sudden deaths were reported in TTT by Grubb and Kosinski. This article summarizes the serious responses in TTT to evaluate the serious response during tilt-table test (TTT) and its prophylactic management. Design and methods:Seventy-six elderly patients (45 males and 31 females, aged 60 to 70 years) suffering from syncope were included in this study. The causes of syncope are still not determined. A thorough clinical investigation including electrocardiogram (ECG), 24-h Holter ambulatory monitoringand echocardiogram, to exclude neural origin diseases or carotid hypersensitivity was done. Before TTT, all patients were advised to stop taking anti-arrhythmia drugs, vas-active drugs and drugs which affect the autonomic nervous system for at least 5 half lives. Seventy-six elderly patients were tested at a tilt angle of 70 degrees for a maximum of 45 min and then subjected to isoproterenol-provocative tilt testing. ECG and blood pressure were monitored during the test and patients were kept at normal saline condition through a peripheral intravenous duct. Results:Fifty-one of 76 patients were defined as positive including 23 having serious response;6 of the 23 patients had arteriosclerosis involving internal carotid arteries and 7 cases had bradycardia, two of which were associated with II °-1 A-V block and the others with chronic atrial fibrillation. The serious response consisted of cardiac arrest for more than 5 s (9 cases), or serious bradycardia for more than 1 min (6 cases), or serious hypotension for more than 1 min (8 cases). Those with serious response were managed by returning to supine position, thus driving up legs and intravenous atropine, CPR (2 cases with cardiac arrest) and needing oxygen supplementation (11 cases). Only 2 hypotension patients recovered rapidly with no complications. Conclusion:Although non-invasive, TTT may result in serious response, especially in elderly. Therefore proper patient selection, control of isoproterenol infusion and close observation of vital signs are decisive for a safe consequence.