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False positive responses to head-up tilt testing in elderly patients with paroxysmal atrial fibrillation.
Rev Port Cardiol. 2008 Nov; 27(11):1383-94.RP

Abstract

The autonomic nervous system (ANS) plays a role as a modulator in the pathogenesis of paroxysmal atrial fibrillation (PAF). The clinical pattern of vagally mediated PAF has been observed mainly in young patients. Neurocardiogenic responses during orthostatic stress are related to autonomic reflexes in which the vagal influence predominates.

AIM

To evaluate the susceptibility of elderly patients with PAF to activation of vasovagal syncope mechanisms.

METHODS

We performed passive head-up tilt testing (HUT) in 34 patients (62% women, aged 72 +/- 7 years), with > or = 1 year of clinical history of PAF--19 without structural heart disease, 11 with hypertensive heart disease and 4 with coronary artery disease (who had no previous myocardial infarction, had undergone myocardial revascularization, and had no documented ischemia) (PAF group), and compared the results with those obtained in a group of 34 age-matched patients (53% women, aged 74 +/- 6 years), who underwent HUT due to recurrent syncope (Sc group). In this group, 21 had no documented heart disease and none had a clinical history of AF. There was no diabetes, congestive heart failure or syncope in the PAF group. After a supine resting period, the subjects were tilted at 70 degrees for 20 minutes while in sinus rhythm. No provocative agents were used to complement the HUT. ECG and blood pressure were continuously monitored (Task Force Monitor, CNSystems). The test was considered positive when syncope or presyncope occurred with bradycardia and/or arterial hypotension. Abnormal responses were classified as cardioinhibitory, vasodepressor or mixed.

RESULTS

HUT was positive in seven patients of the PAF group--vasodepressor response in five and mixed in two (20.5% of the total; 26.3% of those without heart disease)--and in eight patients (vasodepressor in six and mixed in two) of the Sc group (p=NS). During HUT, three patients of the PAF group had short periods of self-limited PAF (in one, after vasodepressor syncope). There were no differences in gender distribution, age or heart disease. No cardioinhibitory responses or orthostatic hypotension were observed.

CONCLUSION

In elderly patients with PAF, a significant number of false positive results during passive HUT may be expected, suggesting increased vasovagal reactions despite aging. This suggests that ANS imbalances may be observed in this population.

Authors+Show Affiliations

Serviço de Cardiologia, Hospital Santa Marta Hospital, Lisboa, Portugal. mmartinsoliveira@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng por

PubMed ID

19227806

Citation

Oliveira, Mário Martins, et al. "False Positive Responses to Head-up Tilt Testing in Elderly Patients With Paroxysmal Atrial Fibrillation." Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology, vol. 27, no. 11, 2008, pp. 1383-94.
Oliveira MM, Feliciano J, Timóteo AT, et al. False positive responses to head-up tilt testing in elderly patients with paroxysmal atrial fibrillation. Rev Port Cardiol. 2008;27(11):1383-94.
Oliveira, M. M., Feliciano, J., Timóteo, A. T., da Silva, N., Antunes, E., Silva, S., Alves, S., Silva-Carvalho, L., & Ferreira, R. (2008). False positive responses to head-up tilt testing in elderly patients with paroxysmal atrial fibrillation. Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology, 27(11), 1383-94.
Oliveira MM, et al. False Positive Responses to Head-up Tilt Testing in Elderly Patients With Paroxysmal Atrial Fibrillation. Rev Port Cardiol. 2008;27(11):1383-94. PubMed PMID: 19227806.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - False positive responses to head-up tilt testing in elderly patients with paroxysmal atrial fibrillation. AU - Oliveira,Mário Martins, AU - Feliciano,Joana, AU - Timóteo,Ana Teresa, AU - da Silva,Nogueira, AU - Antunes,Eduardo, AU - Silva,Sofia, AU - Alves,Sandra, AU - Silva-Carvalho,Luís, AU - Ferreira,Rui, PY - 2009/2/21/entrez PY - 2009/2/21/pubmed PY - 2009/3/6/medline SP - 1383 EP - 94 JF - Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology JO - Rev Port Cardiol VL - 27 IS - 11 N2 - UNLABELLED: The autonomic nervous system (ANS) plays a role as a modulator in the pathogenesis of paroxysmal atrial fibrillation (PAF). The clinical pattern of vagally mediated PAF has been observed mainly in young patients. Neurocardiogenic responses during orthostatic stress are related to autonomic reflexes in which the vagal influence predominates. AIM: To evaluate the susceptibility of elderly patients with PAF to activation of vasovagal syncope mechanisms. METHODS: We performed passive head-up tilt testing (HUT) in 34 patients (62% women, aged 72 +/- 7 years), with > or = 1 year of clinical history of PAF--19 without structural heart disease, 11 with hypertensive heart disease and 4 with coronary artery disease (who had no previous myocardial infarction, had undergone myocardial revascularization, and had no documented ischemia) (PAF group), and compared the results with those obtained in a group of 34 age-matched patients (53% women, aged 74 +/- 6 years), who underwent HUT due to recurrent syncope (Sc group). In this group, 21 had no documented heart disease and none had a clinical history of AF. There was no diabetes, congestive heart failure or syncope in the PAF group. After a supine resting period, the subjects were tilted at 70 degrees for 20 minutes while in sinus rhythm. No provocative agents were used to complement the HUT. ECG and blood pressure were continuously monitored (Task Force Monitor, CNSystems). The test was considered positive when syncope or presyncope occurred with bradycardia and/or arterial hypotension. Abnormal responses were classified as cardioinhibitory, vasodepressor or mixed. RESULTS: HUT was positive in seven patients of the PAF group--vasodepressor response in five and mixed in two (20.5% of the total; 26.3% of those without heart disease)--and in eight patients (vasodepressor in six and mixed in two) of the Sc group (p=NS). During HUT, three patients of the PAF group had short periods of self-limited PAF (in one, after vasodepressor syncope). There were no differences in gender distribution, age or heart disease. No cardioinhibitory responses or orthostatic hypotension were observed. CONCLUSION: In elderly patients with PAF, a significant number of false positive results during passive HUT may be expected, suggesting increased vasovagal reactions despite aging. This suggests that ANS imbalances may be observed in this population. SN - 0870-2551 UR - https://www.unboundmedicine.com/medline/citation/19227806/False_positive_responses_to_head_up_tilt_testing_in_elderly_patients_with_paroxysmal_atrial_fibrillation_ L2 - https://medlineplus.gov/atrialfibrillation.html DB - PRIME DP - Unbound Medicine ER -