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The usefulness of tilt testing with an intravenous beta-blocker in assessing the efficacy of long-term therapy in patients with vasovagal syncope.
Kardiol Pol. 2003 Aug; 59(8):93-104; commentary 103-4.KP

Abstract

BACKGROUND

Although beta blockers are frequently used for the prevention of recurrences of vaso-vagal syncope, the prediction of the long-term efficacy of this treatment is difficult.

AIM

To assess whether the result of tilt testing with an intravenous beta blocker can predict the long-term efficacy of beta blockade.

METHODS

The study group consisted of 62 patients (29 females, mean age 32.8+/-12.3 years and 33 males, mean age 35.9+/-18.2 years) with at least two syncopal episodes during the six months preceding positive tilt testing. After baseline tilt test, propranolol in a dose of 0.1 mg/kg body weight was administered intravenously and the tilt test was repeated. Beta blockade was defined effective if the second tilt test was negative (complete efficacy) or the time to syncope during tilt testing was increased compared with the baseline tilting (partial efficacy). All patients received chronic propranolol treatment and were followed for one year or till the recurrence of syncope.

RESULTS

Intravenous propranolol prevented (n=33) or delayed (n=18) syncope during tilt testing in 51 (82%) patients whereas it was ineffective in the remaining 11 (18%) patients. During 8.6+/-6.7 (range 1-14) months of follow-up, 20 (32%) patients had syncope recurrence; 13 (25%) from the group with effective intravenous propranolol versus 7 (64%) patients in whom intravenous propranolol did not prevent syncope during tilt testing (p<0.015). Analysis of survival without a recurrence of syncope revealed a significant relationship between the results of tilt testing with intravenous propranolol and the efficacy of long-term beta-blocker therapy (p<0.003). There were no significant differences between the predictive value of tilt testing with propranolol between patients with complete or partial propranolol efficacy (NS) whereas significant differences between each of these two groups and patients with ineffective intravenous propranolol were noted (p<0.04 and p<0.002, respectively).

CONCLUSIONS

Propranolol administered intravenously prevents syncope during tilt testing in a significant proportion of patients. Both complete or partial efficacy of intravenous propranolol predict long-term efficacy of chronic beta blocker therapy in patients with vaso-vagal syncope.

Authors+Show Affiliations

Gielerak G
Department of Internal Diseases and Cardiology, Military Medical Institute, Warsaw, Poland.
Makowski K
No affiliation info available
Dłuzniewska E
No affiliation info available
Stec A
No affiliation info available
Cholewa M
No affiliation info available

MeSH

Administration, OralAdrenergic beta-AntagonistsAdultFemaleHumansInfusions, IntravenousMaleMiddle AgedPredictive Value of TestsPropranololSyncope, VasovagalTilt-Table TestTreatment Outcome

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

14560324

Citation

Gielerak, Grzegorz, et al. "The Usefulness of Tilt Testing With an Intravenous Beta-blocker in Assessing the Efficacy of Long-term Therapy in Patients With Vasovagal Syncope." Kardiologia Polska, vol. 59, no. 8, 2003, pp. 93-104; commentary 103-4.
Gielerak G, Makowski K, Dłuzniewska E, et al. The usefulness of tilt testing with an intravenous beta-blocker in assessing the efficacy of long-term therapy in patients with vasovagal syncope. Kardiol Pol. 2003;59(8):93-104; commentary 103-4.
Gielerak, G., Makowski, K., Dłuzniewska, E., Stec, A., & Cholewa, M. (2003). The usefulness of tilt testing with an intravenous beta-blocker in assessing the efficacy of long-term therapy in patients with vasovagal syncope. Kardiologia Polska, 59(8), 93-104; commentary 103-4.
Gielerak G, et al. The Usefulness of Tilt Testing With an Intravenous Beta-blocker in Assessing the Efficacy of Long-term Therapy in Patients With Vasovagal Syncope. Kardiol Pol. 2003;59(8):93-104; commentary 103-4. PubMed PMID: 14560324.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The usefulness of tilt testing with an intravenous beta-blocker in assessing the efficacy of long-term therapy in patients with vasovagal syncope. AU - Gielerak,Grzegorz, AU - Makowski,Karol, AU - Dłuzniewska,Ewa, AU - Stec,Alicja, AU - Cholewa,Marian, PY - 2003/10/16/pubmed PY - 2004/3/24/medline PY - 2003/10/16/entrez SP - 93-104; commentary 103-4 JF - Kardiologia polska JO - Kardiol Pol VL - 59 IS - 8 N2 - BACKGROUND: Although beta blockers are frequently used for the prevention of recurrences of vaso-vagal syncope, the prediction of the long-term efficacy of this treatment is difficult. AIM: To assess whether the result of tilt testing with an intravenous beta blocker can predict the long-term efficacy of beta blockade. METHODS: The study group consisted of 62 patients (29 females, mean age 32.8+/-12.3 years and 33 males, mean age 35.9+/-18.2 years) with at least two syncopal episodes during the six months preceding positive tilt testing. After baseline tilt test, propranolol in a dose of 0.1 mg/kg body weight was administered intravenously and the tilt test was repeated. Beta blockade was defined effective if the second tilt test was negative (complete efficacy) or the time to syncope during tilt testing was increased compared with the baseline tilting (partial efficacy). All patients received chronic propranolol treatment and were followed for one year or till the recurrence of syncope. RESULTS: Intravenous propranolol prevented (n=33) or delayed (n=18) syncope during tilt testing in 51 (82%) patients whereas it was ineffective in the remaining 11 (18%) patients. During 8.6+/-6.7 (range 1-14) months of follow-up, 20 (32%) patients had syncope recurrence; 13 (25%) from the group with effective intravenous propranolol versus 7 (64%) patients in whom intravenous propranolol did not prevent syncope during tilt testing (p<0.015). Analysis of survival without a recurrence of syncope revealed a significant relationship between the results of tilt testing with intravenous propranolol and the efficacy of long-term beta-blocker therapy (p<0.003). There were no significant differences between the predictive value of tilt testing with propranolol between patients with complete or partial propranolol efficacy (NS) whereas significant differences between each of these two groups and patients with ineffective intravenous propranolol were noted (p<0.04 and p<0.002, respectively). CONCLUSIONS: Propranolol administered intravenously prevents syncope during tilt testing in a significant proportion of patients. Both complete or partial efficacy of intravenous propranolol predict long-term efficacy of chronic beta blocker therapy in patients with vaso-vagal syncope. SN - 0022-9032 UR - https://www.unboundmedicine.com/medline/citation/14560324/The_usefulness_of_tilt_testing_with_an_intravenous_beta_blocker_in_assessing_the_efficacy_of_long_term_therapy_in_patients_with_vasovagal_syncope_ DB - PRIME DP - Unbound Medicine ER -