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Tilt Testing (tilt + testing)
Selected AbstractsSingle-Stage Adenosine Tilt Testing in Patients with Unexplained SyncopeJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2004SUNEET MITTAL M.D. Introduction: We previously have shown that a 3-minute single-stage adenosine tilt test has a diagnostic yield comparable to a two-stage protocol consisting of a 30-minute drug-free tilt followed by a 15-minute isoproterenol tilt. In this study, we sought to further define the clinical utility of adenosine tilt testing in patients with unexplained syncope by prospectively evaluating test specificity and determining predictors of a positive test response. Methods and Results: The specificity of single-stage adenosine tilt testing was determined using 30 control subjects. To determine the diagnostic yield of this protocol, adenosine tilts were performed in 129 patients with unexplained syncope. The adenosine tilt test protocol had high specificity (100%) but a low overall diagnostic yield (18%). However, the yield was affected significantly by age. In patients ,40 years of age, the tilt test was positive in 15 (41%) of 37 patients, which was significantly greater than the yield in patients between the ages of 41 and 64 years (6/41 patients [15%], P = 0.012) and those ,65 years of age (2/41 patients [5%], P < 0.0001). Conclusion: These data support single-stage adenosine tilt testing in patients ,40 years of age because the diagnostic yield of the test is maximal in this group and the test can be completed in ,3 minutes. Conversely, the diagnostic yield of adenosine tilt testing in patients >40 years of age is low, suggesting that the clinical utility of this protocol is limited in these patients. (J Cardiovasc Electrophysiol, Vol. 15, pp. 1-4, June 2004) [source] How Revealing Are Insertable Loop Recorders in Pediatrics?PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2008PATRICIA A. FRANGINI M.D. Introduction: An insertable loop recorder (ILR) in patients with infrequent syncope or palpitations may be useful to decide management strategies, including clinical observation, medical therapy, pacemaker, or implantable cardioverter defibrillator (ICD). We sought to determine the diagnostic utility of the Reveal® ILR (Medtronic, Inc., Minneapolis, MN, USA) in pediatric patients. Methods: Retrospective review of clinical data, indications, findings, and therapeutic decision in 27 consecutive patients who underwent ILR implantation from 1998,2007. Results: The median age was 14.8 years (2,25 years). Indications were syncope in 24 patients and recurrent palpitations in three. Overall, eight patients had structural heart disease (six congenital heart disease, one hypertrophic cardiomyopathy, one Kawasaki), five had previous documented ventricular arrhythmias with negative evaluation including electrophysiology study, and three patients had QT prolongation. Tilt testing was performed in 10 patients, of which five had neurocardiogenic syncope but recurrent episodes despite medical therapy. After median three months (1,20 months), 17 patients presented with symptoms and the ILR memory was analyzed in 16 (no episode stored in one due to full device memory), showing asystole or transient atrioventricular (AV) block (2), sinus bradycardia (6), or normal sinus rhythm (8). Among asymptomatic patients, 3/10 had intermittent AV block or long pauses, automatically detected and stored by the ILR. In 19 of 20 patients, ILR was diagnostic (95%) and five subsequently underwent pacemaker implantation, while seven patients remained asymptomatic without ILR events. Notably, no life-threatening events were detected. The ILR was explanted in 22 patients after a median of 22 months, two due to pocket infection, 12 for battery depletion and eight after clear documentation of nonmalignant arrhythmia. Conclusions: The ILR in pediatrics is a useful adjunct to other diagnostic studies. Patient selection is critical as the ILR should not be utilized for malignant arrhythmias. A diagnosis is attained in the majority of symptomatic patients, predominantly bradyarrhythmias including pauses and intermittent AV block. [source] Usefulness of the Head-Upright Tilt Test for Distinguishing Syncope and Epilepsy in ChildrenEPILEPSIA, Issue 6 2001J. Eirís-Puñal Summary: ,Purpose: Episodic loss of consciousness in children, whether or not associated with hypertonia or short-duration clonic movements, presents a diagnostic challenge to the pediatrician and child neurologist. We provide some evidence of the usefulness of the head-upright tilt test for investigating the causes of transient loss of consciousness in children, and for distinguishing between syncope, convulsive syncope, and epilepsy. Methods: We studied nine children previously diagnosed as epileptic on the basis of compatible clinical events and epileptiform findings in routine EEGs who were treated over the long term with antiepileptic drugs, but whose clinical records suggested syncope or convulsive syncope rather than epilepsy on reevaluation. All subjects underwent head-upright tilt testing. Results: The tilt-test result was positive in all nine cases, with the patients reporting the same symptoms as in the previously considered epileptic attacks. Conclusions: Inadequate histories and misuse/overinterpretation of EEG results often lead to misdiagnosis of epilepsy in children. The head-upright tilt test is a useful and reliable diagnostic technique, allowing syncopal events to be induced and evaluated under controlled conditions. In a subset of patients, it may help to distinguish epilepsy from simple or convulsive syncope. [source] Single-Stage Adenosine Tilt Testing in Patients with Unexplained SyncopeJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2004SUNEET MITTAL M.D. Introduction: We previously have shown that a 3-minute single-stage adenosine tilt test has a diagnostic yield comparable to a two-stage protocol consisting of a 30-minute drug-free tilt followed by a 15-minute isoproterenol tilt. In this study, we sought to further define the clinical utility of adenosine tilt testing in patients with unexplained syncope by prospectively evaluating test specificity and determining predictors of a positive test response. Methods and Results: The specificity of single-stage adenosine tilt testing was determined using 30 control subjects. To determine the diagnostic yield of this protocol, adenosine tilts were performed in 129 patients with unexplained syncope. The adenosine tilt test protocol had high specificity (100%) but a low overall diagnostic yield (18%). However, the yield was affected significantly by age. In patients ,40 years of age, the tilt test was positive in 15 (41%) of 37 patients, which was significantly greater than the yield in patients between the ages of 41 and 64 years (6/41 patients [15%], P = 0.012) and those ,65 years of age (2/41 patients [5%], P < 0.0001). Conclusion: These data support single-stage adenosine tilt testing in patients ,40 years of age because the diagnostic yield of the test is maximal in this group and the test can be completed in ,3 minutes. Conversely, the diagnostic yield of adenosine tilt testing in patients >40 years of age is low, suggesting that the clinical utility of this protocol is limited in these patients. (J Cardiovasc Electrophysiol, Vol. 15, pp. 1-4, June 2004) [source] The diagnostic protocol in children and adolescents with syncope: a multi-centre prospective studyACTA PAEDIATRICA, Issue 5 2009Qingyou Zhang Abstract Aim: The appropriate diagnostic protocol for children with syncope has not been well established. A diagnostic protocol was developed and prospectively implemented to improve the diagnostic performance of paediatricians. Methods: The study population included 474 consecutive patients (range 6,17 years) presenting with a syncopal spell in one of the five participating hospitals of China. In step 1, all patients underwent initial evaluation for history, physical examination, standing test and standard electrocardiography (ECG). In step 2, priority was given to cardiographic tests for possibly cardiogenic syncope, or electroencephalographic examination and brain imaging for suspected neurological syncope, or psychiatric tests for suspected psychiatric syncope. Patients with unexplained syncope underwent head-up tilt testing (HUT). Results: The initial evaluation gave a definite diagnosis in 59 (12.4%) and possible diagnosis in 54 of the 474 patients. Further testing gave a definite diagnosis for 326 patients (69.7%). After the entire diagnostic protocol, definite diagnosis was established in 385 patients (81.1%). Autonomic-mediated reflex syncope (AMS) accounted for 73.0% of cases. The average cost of diagnostic results per patient was RMB 1030.24 ± 150.09 ($118.42 ± 17.25). Conclusion: The use of a simplified diagnostic protocol for children and adolescents with syncope improves diagnostic yield. [source] | ||||||||||