Research Article Open Access
Volume 2 | Issue 3 | DOI: https://doi.org/10.33696/cardiology.2.018

Asystole during Tilt Testing-Induced Syncope: A Long-Term Follow-Up

  • 1Unidad Médica de Alta Especialidad Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Servicio de Electrofisiología,Instituto Mexicano del Seguro Social, Universidad Nacional Autónoma de México, Ciudad de México, México
  • 2Hospital Central Norte de Concentración Nacional, Pemex Servicio de Cardiología y Unidad de Cuidados Intensivos Cardiológicos, Universidad Nacional Autónoma de México, Ciudad de México, México
  • 3Unidad Médica de Alta Especialidad, Hospital de Especialidades Dr. Bernardo Sepúlveda Centro Médico Nacional Siglo XXI,Servicio de Cardiología, Instituto Mexicano del Seguro Social, Universidad Nacional Autónoma de México, Ciudad de México,México
  • 4Centro Médico Dalinde 2000, Hospital Ángeles Clínica Londres, Centro Hospitalario Sanatorio Durango, Ciudad de México, México
+ Affiliations - Affiliations

Corresponding Author

Enrique Velázquez Rodríguez, enve@prodigy.net.mx

Received Date: June 22, 2021

Accepted Date: August 24, 2021


Background: Tilt-table testing is safe and low-risk, but asystole of variable duration may be tilt-induced and, it was suggested that it could represent a life-threatening manifestation of vasovagal syncope. We performed a retrospective observational study evaluating the clinical characteristics and long-term outcome in patients with asystole during tilt-induced syncope.

Methods: A cohort of 552 patients referred for evaluation of recurrent syncope of unknown etiology underwent to a modified passive and active protocol tilt-table testing.

Results: 68% were positive to neurally mediated reflex syncope with 41 (11%) cases of asystole. Twenty-eight women (68%), mean age 26 ± 13 years and thirteen men, 31 ± 7 years had syncope with asystolic pause = 3 seconds during baseline, 27 of 41 (66%) or pharmacological challenge test, 14 of 41 (34%). The mean duration of asystole was 12.6 ± 11.3 seconds and, 80% of cases had sinus arrest = 5 seconds. 32 of 41 (78%) patients were successfully followed-up during a mean of 5.3 ± 1.5 years (range 1.5 to 8); 87.5% of patients had = 5 years of follow-up. Therapy was not guided based on the results of tilt-table testing and pharmacologic therapy with ß-blockers was generally effective. During long-term follow-up, only 12.5% had syncope recurrence and in 37.5% drugs were withdrawn after a long asymptomatic period.

Conclusion: Asystole during tilt-induced syncope does not necessarily predict adverse outcomes with most patients having a benign clinical course and improving with lifestyle changes and pharmacologic therapy and even spontaneously over a long-term follow-up.


Asystole, Vasovagal syncope, Tilt-table test, Cardioinhibitory syncope, Vasodepressor syncope, Neurocardiogenic syncope, Tilt-induced asystole

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