14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

RT-183

A new classification of the haemodynamics of vasovagal syncope. Analysis of the preparatory (pre-syncopal) phase of the tilt testing without and with nitroglycerin challenge

Carlo Menozzi, Michele Brignole*, Attilio Del Rosso**, Silvia Costa*, Germano Gaggioli*, Alberto Solano*, Nicola Bottoni, Paolo Bartoli**, Richard Sutton***.
Arrhythmologic Centre, Ospedale S. Maria Nuova, Reggio Emilia, *Arrhythmologic Centre, Ospedali Riuniti, Lavagna, **Department of Cardiology, Ospedale S. Pietro Igneo, Fucecchio, Italy, ***Department of Cardiology, Royal Brompton Hospital, London, UK

Worldwide experience of more than 10 years of tilt testing has shown that, while it has dramaticaly reduced the numbers of patients who remain without an explanation of syncope, the population of patients who show a positive response to the test is greatly heterogeneous, raising the possibility that different syndromes can be diagnosed by tilt testing. Many drugs as well as cardiac pacing have been proposed for patients with tilt-induced syncope; however a consensus on management has not been achieved due to the unsatisfactory results of trials of therapy which have been undertaken. The classification of the Vasovagal Syncope International Study (VASIS) was developed in 1992 in order to facilitate the understanding of the different types of vasovagal reactions which were observed during tilt-induced syncope¹. This has been recently extended to tilt testing with pharmacological challange^2,3. Like the other current classifications of the positive responses to tilt testing, the VASIS classification is based on the different behaviour of the blood pressure and heart rate observed when the vasovagal reaction and symptoms occurs. To date, the cardiovascular patterns preceding the development of the vasovagal reaction have received little study. We believe that the pattern of blood pressure response to tilt may provide more strict diagnostic information and that a more detailed although still arbitrary classification may form the basis of a number of future drug and pacemaker trials as well as it may help us toward a better understanding of the different mechanisms of tilt-induced syncope. We therefore, propose the following classification to be used as complimentary and additive to the VASIS classification. Moreover we tried to correlate this classification with some simple clinical variables.