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European Heart Journal 1992 13(10):1416-1421;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Prolonged cardiac arrest and complete AV block during upright tilt test in young patients with syncope of unknown origin-prognostic and therapeutic implications

A. F. FOLINO, G. F. BUJA, B. MARTINI, M. MIORELLI and A. NAVA

Department of Cardiology, University of Padova Italy

Received 28 June 1991; revised 24 April 1992; .

Correspondence. Dr A. F. Folino. Cattedra di Cardiologia. Universila di Padova, via Giusuniani. 2, 35100 Padova, Italy

Abstract

The purpose of this study was to define the history and prognosis of 12 patients (8 males, 4 females) with syncope of unknown origin (5 to 15 episodes), who developed prolonged asystole or complete A V block during the upright lilt test (UTT). The mean age (±SD) of the patients was 29±7·4 years, and all had normal neurological and cardiological findings on evaluation. These patients were selected from a larger group of 92 cases with positive UTT out of a total of 136 subjects who were referred for recurrence of syncope. Neither clinical nor autonomic nervous system evaluation distinguished these 12 patients from those with positive UTT. Following UTT, therapy was initiated and consisted of transdermal scopolamine in four, disopyramide in two, and fi-blockers in four patients.

During follow-up (mean, 17±5·4 months), four patients had recurrences but none experienced episodes of life-threatening syncope.

These patients do not show an enhanced risk of sudden death, and drug therapy seems to improve their clinical course. Only long-term follow-up would correctly identify a subgroup at higher risk.

Key Words: Syncope • upright tilt test • asystole


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