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

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

RT-185

Clinical neuromediated syncope: risk factors for syncope recurrence after tilt-table testing in untreated patients

Giovanni Foglia Manzillo, MarioComelli*, GiovanniCorrado, GiorgioTadeo, Luca Mario Tagliagambe, Manuela Spata, Mauro Santarone.
Department of Cardiology, H. Valduce, Como and *Dpt. of Epidemiology and Medical Statistics, Pavia University, Pavia, Italy

Abstract

The purpose of this prospective study was to analyze the natural history of patients with clinical neurocardiogenic syncope, who were not treated after a sublingual nitroglycerin/head-up tilt-table test. Ninety-two consecutive pts with at least two episodes of syncope, a negative work-up for other causes of syncope and either(1) a positive tilt-table testing or (2) a typical history of neurocardiogenic syncope despite a negative tilt test were monitored for a mean period of 14±12 months (median 10.5). The primary outcome measure was the time to the first recurrence of syncope. Of 92 pts 20 (22%) had recurrent syncope during follow-up. The actuarial probabilities of remaining symptoms free after 1 and 2 years were 82 and 71% respectively. The mean frequency of syncopal episodes dropped from 0.4±0.6 to 0.08±0.2/month after head-up tilting. Positive result at tilt testing was not predictive of recurrence of syncope. Multivariate proportional hazards analysis demonstrated that the most powerful predictors of recurrent syncope were the number of syncopal spells in the previous 2 years, the duration of syncopal symptoms and, among intratest variables, peak systolic blood pressure during the test.

In conclusion, in our study recurrence of syncopal episodes in drug-free patients with clinical neuromediated syncope became less frequent after tilt testing. The risk of a recurrence of syncope can be predicted with simple pretest and intratest variables.

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