Combined Diagnostic Yield of Tilt Table Test And Implantable Loop Recorder to Identify Patients Affected by Severe Clinical Presentation of Neurally-Mediated Reflex Syncope who Could Respond to Cardiac Pacing.

In this study we wanted to verify the diagnostic value of tilt table test (TTT) to predict the efficacy of cardiac pacing (PM) for preventing recurrences of neurally mediated reflex syncope (NMS) in patients with cardioinhibitory activity (CI) documented by implantable loop recorder (ILR). Among patients selected by ILR in the context of severe clinical presentation of NMS, we analysed those who underwent PM implantation. In this observational and retrospective study we wanted to verify the results of TTT in the groups of treated patients with and without recurrences. We analysed 24 patients treated using a PM (10 male and 14 female, mean age 70 years). During an average follow-up period of 35 months the recurrence of syncope occurred in 7 patients (29%). 17 patients (71%) had not recurrences. TTT was negative in 15 patients out of 17 without recurrences (88%). Among the 7 patients with recurrences TTT was positive in 4 patients (57%). In conclusion, in this selected group of patients, a positive response to TTT is more likely correlated with a higher frequency of recurrences of syncope, while a negative response seems to predict the success of the pacing therapy. Consequently, PM could be insufficient to prevent the recurrences in the group of patients with positive TTT.