COMPARISON OF DIFFERENT TYPES OF RESPONSES TO TILT-TABLE TESTING IN PATIENTS OF BOTH GENDERS WITH UNEXPLAINED SYNCOPE

Abstract

Objective: To compare the frequency of various types of responses in both genders undergoing tilt table test with
unexplained syncope.

Study Design: A comparative cross-sectional study.

Place and Duration of Study: Department of EP studies, Armed Forces Institute of Cardiology and National
Institute of Heart Diseases, Rawalpindi, from Aug 2017 to Jan 2018.

Material and Methods: Patients were recruited through non-probability consecutive sampling. Patients of all age
groups of both genders who had syncope as per operational definition were included in our study. Patients who
were excluded from the study were, newly diagnosed or previously established history of arrhythmias, coronary
artery disease, cardiomyopathies and structural heart disease e.g. HOCM, aortic stenosis, mitral stenosis. Patients
who had history of epilepsy on medical record and history of anemia on medical record were also excluded from
the study. Base line demographic information of patients (age, gender, duration of complain) and types of
responses were recorded on especially designed proforma.

Results: Total 294 patients were recruited for the study. Mean age of the patients was 46.7 ± 8.1 years, with
minimum age 12 years and maximum age 85 years. Male patients were found to be 244 (82.4%) while female
patients were 50 (16.9%). Mean duration of complaints was 1.5 ± 1.7 months. Our study showed that the most
common type of response in male and females were mixed type (88.1%) and (84%) respectively, with the p-value
of 0.022. while, cardioinhibitory type response was (2.8%) but found in male gender only. Next most common
type was vasodepressor type response common in females than males with 6% and 2.4% respectively.
Subsequently, less frequent type of response was showed with classic type of orthrostatic hypotension (2%) while
type Initial orthrostatic hypotension was not recoreded in the study. Females were more frequent than males in
Progressive orthrostatic hypotension with (5%) and (0.4%) in males. POTS response was not present in either
gender.

Conclusion: As our study showed, among type of responses, mixed type of response has a significantly
high positive rate being more common in male gender, while vasodepressive type and progressive
orthostatic hypotension type being more common in female gender. Tilt-table testing plays a major role
during the evaluation of syncope patients, helps to differentiate syncope subtypes and could be useful
in guiding treatment. however, the need for using another protocol with a similar diagnostic accuracy
in gender specificity is necessary.