{
    "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.",
    "authors": [
        {
            "affiliation": "Chair of Cardiology, University of the Study of Campania 'Luigi Vanvitelli', Ospedale Monaldi, Via Leonardo Bianchi, 80131 Napoli, Italy.",
            "firstname": "Vincenzo",
            "initials": "V",
            "lastname": "Russo"
        },
        {
            "affiliation": "Chair of Cardiology, University of the Study of Campania 'Luigi Vanvitelli', Ospedale Monaldi, Via Leonardo Bianchi, 80131 Napoli, Italy.",
            "firstname": "Erika",
            "initials": "E",
            "lastname": "Parente"
        },
        {
            "affiliation": "IRCCS Istituto Auxologico Italiano, Faint & Fall programme, Cardiology Unit and Department of Cardiology, S.Luca Hospital, Piazzale Brescia 2, 20149 Milan, Italy.",
            "firstname": "Antonella",
            "initials": "A",
            "lastname": "Groppelli"
        },
        {
            "affiliation": "Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy.",
            "firstname": "Giulia",
            "initials": "G",
            "lastname": "Rivasi"
        },
        {
            "affiliation": "Ospedale Generale Regionale, Via Lorenz B\u00f6hler, 5, 39100 Bolzano, Italy.",
            "firstname": "Marco",
            "initials": "M",
            "lastname": "Tomaino"
        },
        {
            "affiliation": "Research Clinical Unit, BIOTRONIK Italia S.p.A., Via Alessandro Volta 16, 20093 Cologno, Monzese, Italy.",
            "firstname": "Alessio",
            "initials": "A",
            "lastname": "Gargaro"
        },
        {
            "affiliation": "Research Clinical Unit, BIOTRONIK Italia S.p.A., Via Alessandro Volta 16, 20093 Cologno, Monzese, Italy.",
            "firstname": "Daniele",
            "initials": "D",
            "lastname": "Giacopelli"
        },
        {
            "affiliation": "Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy.",
            "firstname": "Andrea",
            "initials": "A",
            "lastname": "Ungar"
        },
        {
            "affiliation": "IRCCS Istituto Auxologico Italiano, Faint & Fall programme, Cardiology Unit and Department of Cardiology, S.Luca Hospital, Piazzale Brescia 2, 20149 Milan, Italy.",
            "firstname": "Gianfranco",
            "initials": "G",
            "lastname": "Parati"
        },
        {
            "affiliation": "Department of Cardiology, Karolinska Institute, Nobels v\u00e4g 6, 171 77 Solna, Stockholm, Sweden.\nDepartment of Medicine, Karolinska Institute, Nobels v\u00e4g 6, 171 77 Solna, Stockholm, Sweden.",
            "firstname": "Artur",
            "initials": "A",
            "lastname": "Fedorowski"
        },
        {
            "affiliation": "National Heart and Lung Institute, Imperial College, Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.",
            "firstname": "Richard",
            "initials": "R",
            "lastname": "Sutton"
        },
        {
            "affiliation": "Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300RC Leiden, The Netherlands.",
            "firstname": "J Gert",
            "initials": "JG",
            "lastname": "van Dijk"
        },
        {
            "affiliation": "IRCCS Istituto Auxologico Italiano, Faint & Fall programme, Cardiology Unit and Department of Cardiology, S.Luca Hospital, Piazzale Brescia 2, 20149 Milan, Italy.",
            "firstname": "Michele",
            "initials": "M",
            "lastname": "Brignole"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.",
    "doi": "10.1093/europace/euac154",
    "journal": "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",
    "keywords": [
        "Asystole",
        "Cardiac pacing",
        "Cardioinhibition",
        "Head-up tilt testing",
        "Syncope",
        "Vasodepression"
    ],
    "methods": null,
    "publication_date": "2023-02-17",
    "pubmed_id": "36796797\n33624801\n34586378\n24153416\n28669088\n29562291\n23041006\n11863351\n7732979\n8455666\n7832133\n15464873\n25940375\n29429639\n7618622\n27988280\n12651049\n29759842\n9539468\n12164986\n17911368\n32176097\n26443446\n32460687\n35524080\n33564843\n21420055\n11194602\n11225598\n24336948\n29267867\n33279955\n32036025\n33740206",
    "results": null,
    "title": "Prevalence of asystole during tilt test-induced vasovagal syncope may depend on test methodology.",
    "xml": "<Element 'PubmedArticle' at 0x78850424eed0>"
}