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Randomized Controlled Trial
. 2022 Aug;43(8):4847-4851.
doi: 10.1007/s10072-022-06079-8. Epub 2022 Apr 21.

Comparison of pain-provoked versus standard 40-min tilt table test for the conformation of vasovagal syncope

Ivan Adamec  1   2 , Anamari Junaković  3 , Magdalena Krbot Skorić  3   4 , Mario Habek  3   5
Affiliations
Randomized Controlled Trial

Comparison of pain-provoked versus standard 40-min tilt table test for the conformation of vasovagal syncope

Ivan Adamec et al. Neurol Sci. 2022 Aug.

Abstract

Background: Tilt table test represents a valuable diagnostic method in assessing patients with transient loss of consciousness and confirming the diagnosis of vasovagal syncope. However, the test lacks standardization, and various protocols exist in different centers. The aim of this study was to compare the difference in sensitivity and time-to-syncope of tilt table test with a painful stimulus provocation compared to standard test with no provocation.

Methods: This was a prospective study that included consecutive patients diagnosed with vasovagal syncope who were referred for tilt table testing. Patients were randomly assigned to two groups: group 1 with pain provocation after the first 10 min of upright position and group 2 with no provocation with further 30 min of tilt in both groups.

Results: In group 1, 66 (78.6%) patients developed syncope while in group 2, 35 (44.3%) patients had syncope (p < 0.001). This represents an increase of 34.3% in TTT sensitivity with the application of painful provocation. According to results of the Cox regression, the hazard for developing syncope after the 10th min of the tilt for group 2 was 0.275 of the hazard of group 1 (95% C.I. 0.170-0.444, p < 0.001).

Conclusion: Pain provocation is a useful method for increasing sensitivity and shortening the duration of tilt table testing.

Keywords: Pain provocation; Syncope; Tilt table test; Vasovagal.

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