ReviewEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2023
Prevalence of asystole during tilt test-induced vasovagal syncope may depend on test methodology.
Review in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 28 citations in OpenAlex.
- Head-up tilt testing in older syncope patients: a systematic review.Age and ageing · 2025Pooled it
- Now is the time to take syncope seriously.The British journal of cardiology · 2026Article
- Recurrent Syncope in Patients With Reflex Syncope Treated With Dual-Chamber Pacemakers: Short-Term Associated Factors-A Single-Center Retrospective Study.Journal of arrhythmia · 2025Article
- Syncope: Advances in Diagnosis and Treatment 2024.Journal of cardiovascular electrophysiology · 2025Review
- Mechanism of syncope: role of ambulatory blood pressure monitoring and cardiovascular autonomic function assessment.European heart journal · 2025Observational
- Temporal relationship between haemodynamic changes and activation of closed-loop stimulation during a tilt-induced vasovagal syncope.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Observational
- A cross-sectional nationwide survey of guideline based syncope units in the Netherlands: the SU-19 score-a novel validation for best practices.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Article
- Variability of cardioinhibition in vasovagal syncope: differences between subgroups during cardioinhibition and beyond.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2023Article
- Twenty-five years of research on syncope.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Article
- Definitive aetiology of unexplained syncope after cardiovascular autonomic tests in a tertiary syncope unit.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Article
- Vasovagal Syncope at Work: A Narrative Review for an Occupational Management Proposal.International journal of environmental research and public health · 2023Review
- Development of a nomogram model to predict malignant vasovagal syncope in Chinese children.Frontiers in pediatrics · 2023Article
- Cardioinhibitory syncope with asystole during nitroglycerin potentiated head up tilt test: prevalence and clinical predictors.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2022Article
- A contemporary review of the head-up tilt test: Utility and limitations.Indian heart journalReview
Corrections and comments
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Authors and funding
13 authors at 7 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This review addresses tilt-testing methodology by searching the literature which reports timing of asystole and loss of consciousness (LOC). Despite the Italian protocol being the most widely adopted, its stipulations are not always followed to the letter of the European Society of Cardiology guidelines. The discrepancies permit reassessment of the incidence of asystole when tilt-down is early, impending syncope, compared with late, established LOC. Asystole is uncommon with early tilt down and diminishes with increasing age. However, if LOC is established as test-end, asystole is more common, and it is age-independent. Thus, the implications are that asystole is commonly under-diagnosed by early tilt-down. The prevalence of asystolic responses observed using the Italian protocol with a rigorous tilt down time is numerically close to that observed during spontaneous attacks by electrocardiogram loop recorder. Recently, tilt-testing has been questioned as to its validity but, in selection of pacemaker therapy in older highly symptomatic vasovagal syncope patients, the occurrence of asystole has been shown to be an effective guide for treatment. The use of head-up tilt test as an indication for cardiac pacing therapy requires pursuing the test until complete LOC. This review offers explanations for the findings and their applicability to practice. A novel interpretation is offered to explain why pacing induced earlier may combat vasodepression by raising the heart rate when sufficient blood remains in the heart.
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