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American Heart Association

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Final ID: Mo3021

The Diagnosis of Vasovagal Syncope Requires an Extended Duration of the Head-Up Tilt Table Test

Abstract Body (Do not enter title and authors here): Background:
Vasovagal syncope (VVS) is a type of reflex syncope in which transient loss of consciousness is caused by reflex vasodepression and/or cardioinhibition leading to cerebral hypoperfusion. VVS is the most common type of syncope, accounting for more than one third of the types of syncope. A head-up tilt table test (HUTT) can be helpful in confirming this diagnosis. However, the optimal duration of a HUTT in this evaluation is unclear. While many centers use a 10-minute tilt duration, a 45-minute tilt duration may increase diagnostic yield.

Aims:
To assess the time while upright during a HUTT until a vasovagal response occurs.

Methods:
We conducted a retrospective analysis of patients who underwent a 45-minute passive HUTT in the evaluation of clinical symptoms who had a vasovagal response during the test (n = 386). . To assess the diagnostic yield of longer-duration tilt testing (45-minutes), we simulated a shorter duration HUTTs (10-minutes). We then performed a McNemar’s exact test to compare the number of patients who would have been diagnosed by a shorter duration HUTT versus full duration HUTT. Unpaired t-tests were performed to compare the mean time to positivity between subgroups.

Results:
351 out of 386 patients had a positive VVS diagnosis beyond the 12-minute mark of the full-duration HUTT. The average time to positivity was 27.9 ± 11.9 min. Among patients aged >40 years, the mean time to positivity was significantly longer when compared to those ≤40 years (29.8 ± 12.5 min vs. 24.4 ± 11.7 min, p < 0.001). No significant difference was noted between sexes (males: 28.1 ± 12.3 min vs. 27.2 ± 12.4 min, p = 0.533).

Conclusions:
This analysis shows that a 10-minute HUTT excludes many patients with VVS, especially in older patients. These findings support the use of longer-duration HUTT for diagnosing VVS.
  • Eid, Mohab  ( Cleveland Clinic Foundation , Cleveland , Ohio , United States )
  • Ramonfaur, Diego  ( Cleveland Clinic Foundation , Cleveland , Ohio , United States )
  • Honnekeri, Bianca  ( Cleveland Clinic Foundation , Cleveland , Ohio , United States )
  • Mendpara, Vaidehi  ( Cleveland Clinic Foundation , Cleveland , Ohio , United States )
  • Watfa, Adele  ( Cleveland Clinic Foundation , Cleveland , Ohio , United States )
  • Mayuga, Kenneth  ( Cleveland Clinic Foundation , Cleveland , Ohio , United States )
  • Author Disclosures:
    Mohab Eid: DO NOT have relevant financial relationships | Diego Ramonfaur: DO NOT have relevant financial relationships | Bianca Honnekeri: No Answer | Vaidehi Mendpara: DO NOT have relevant financial relationships | Adele Watfa: DO NOT have relevant financial relationships | Kenneth Mayuga: DO NOT have relevant financial relationships
Meeting Info:

Scientific Sessions 2025

2025

New Orleans, Louisiana

Session Info:

Electrophysiology in Practice: Diverse Clinical Cases and Research Highlights

Monday, 11/10/2025 , 01:00PM - 02:00PM

Abstract Poster Board Session

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Comparative Analysis of Prodromal Symptoms in Head-Up Tilt Test vs. Spontaneous Vasovagal Syncope

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Orthostatic Hypotension in Patients with Heart Failure taking Carvedilol or Metoprolol

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