What is the optimal duration of tilt testing for the assessment of patients with suspected postural tachycardia syndrome? – Source: Europace, May 2009

[Note: POTS (postural orthostatic tachycardia syndrome) is an excessive increase in heart rate on rising to upright position. Vasovagal syncope (light headedness/fainting) is an abnormal reflex of the vagus nerve (the nerve of the muscle in the throat and the larynx). Whereas it normally sends signals to speed heart rate/raise blood pressure as needed when the subject rises to sitting or standing, the vagus nerve “withdraws the message” and blood flow to the brain is decreased.]

Aims: The aim of this study is to define the optimal duration of tilt testing for the assessment of patients with suspected postural tachycardia syndrome (POTS).

Methods and Results: This was a case-control study. Cases were identified retrospectively from a database of patients referred with orthostatic intolerance (OI). All met the diagnostic criteria for POTS. Controls were enrolled prospectively.

All subjects underwent tilting to 70 degrees for 40 min if tolerated. Continuous monitoring was provided by a Finometer. Analysis of responses to tilting was performed on 28 cases and 28 controls. The mean age in the case group was 23.6 and in the control group was 26.2. The majority was female in both groups (cases = 4F:3M, controls = 2F:1M).

All cases met the criteria for POTS within 7 min of orthostasis. No controls demonstrated a sustained tachycardia.

The prevalence of vasovagal syncope (VVS) was 36% in cases vs. 7% in controls (P = 0.02) and 25% in the remaining patients (n = 233) on the OI database (P = 0.259).

• A 10 min tilt will diagnose POTS in the majority of patients.
• It will not, however, be sufficient to identify the overlap that exists between POTS and vasovagal syncope.
• The optimal duration of tilt testing in patients suspected of POTS is 40 min.

Source: Europace, May 2009;11(5):635-7. PMID: 19264762, by Carew S, Cooke J, O'Connor M, Donnelly T, Costelloe A, Sheehy C, Lyons D. Clinical Age Assessment Unit, Mid-Western Regional Hospital, Dooradoyle, Limerick, Ireland. [E-mail: sheila.carew@hse.ie]

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