Cardioinhibitory syncope with asystole during nitroglycerin potentiated head up tilt test: prevalence and clinical predictors

• Published in: Clinical autonomic research Vol. 32; no. 3; pp. 167 - 173
• Main Authors: Russo, Vincenzo, Parente, Erika, Rago, Anna, Comune, Angelo, Laezza, Nunzia, Papa, Andrea Antonio, Chamberland, Celeste, Huynh, Thao, Golino, Paolo, Brignole, Michele, Nigro, Gerardo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2022; Springer Nature B.V
• Subjects: Cardiology; Diabetes; Diuretics; Endocrinology; Female; Gastroenterology; Heart Arrest - chemically induced; Heart Arrest - diagnosis; Heart Arrest - epidemiology; Humans; Male; Medicine; Medicine & Public Health; Multivariate analysis; Neurology; Nitroglycerin; Nitroglycerin - adverse effects; Ophthalmology; Patients; Prevalence; Research Article; Retrospective Studies; Smoking; Syncope; Syncope - chemically induced; Syncope - diagnosis; Syncope - epidemiology; Syncope, Vasovagal - chemically induced; Syncope, Vasovagal - diagnosis; Syncope, Vasovagal - epidemiology; Tilt-Table Test; Gender; Syncope; Asystole; Age; Predictors; Reflex neurally mediated
• ISSN: 0959-9851; 1619-1560; 1619-1560
• DOI: 10.1007/s10286-022-00864-3

Aims The aim of our study was to evaluate the prevalence and clinical predictors of cardioinhibitory (CI) responses with asystole at the nitroglycerin (NTG)-potentiated head-up tilt test (HUTT) in patients with a history of syncope admitted to a tertiary referral syncope unit. Methods We retrospectively evaluated all consecutive patients who underwent NTG-potentiated HUTT for suspected reflex syncope at our institution from March 1 2017 to May 1 2020. The prevalence of HUTT-induced CI syncope was assessed. Univariate and multivariate analyses were performed to test the association of asystolic response to HUTT with a set of clinical covariates. Results We enrolled 1285 patients (45 ± 19.1 years; 49.6% male); 368 (28.6%) showed HUTT-induced CI response with asystole. A multivariate analysis revealed that the following factors were independently associated with HUTT-induced CI syncope: male sex (OR 1.48; ConInt 1.14–1.92; P  = 0.003), smoking (OR 2.22; ConInt 1.56–3.115; P  < 0.001), traumatic syncope (OR: 2.81; ConInt 1.79–4.42; P  < 0.001), situational syncope (OR 0.45; ConInt 0.27–0.73; P  = 0.002), and the use of diuretics (OR 9.94; ConInt 3.83–25.76; P  < 0.001). Conclusions The cardioinhibitory syncope with asystole induced by NTG-potentiated HUTT is more frequent than previously reported. The male gender, smoking habit, history of traumatic syncope, and use of diuretics were independent predictors of HUTT-induced CI responses. Conversely, the history of situational syncope seems to reduce this probability.