Cor Vasa 2007, 49(3):92-94 | DOI: 10.33678/cor.2007.036

The neurocardiogenic response during the head-up tilt test in patients with permanent atrial fibrillation

Miroslava Laníková^*, Petr Pařízek, Martin Hodač

I. interní klinika, Fakultní nemocnice Hradec Králové, Hradec Králové, Česká republika

Introduction:
Syncope is a relatively serious symptom in patients with atrial fibrillation (AF). Aside from arrhythmic syncopes, there are neurocardiogenic syncopes (NCSs), based on the autonomic nervous system s reflex mechanism, in patients with AF. The hemodynamic consequences of AF affect the function of the autonomic nervous system. As a result, patients with AF may be at higher risk of developing NCS. No data is available on the incidence of NCS in patients with permanent AF.

Aim:
To evaluate the NCS response during the head-up tilt test in patients with permanent AF.

Method:
Forty-eight patients (19 women, 29 men; mean age of 69 years) with permanent AF were enrolled. Of this number, 17 had a history of syncope (35%; 9 women, 8 men). Basal head-up tilt test (HUT) was performed. The patients continued to take their long-term medication during the period of testing.

Results:
Neurocardiogenic syncopes manifested in 13 patients during HUT (27%, 7 women, 6 men); 7 (41%) of the17 pa-tients with a history of syncope tested positively for NCS during HUT as well as 6 (19%) of the 31 patients without a history of syncope. We noted a tendency towards a higher incidence of positive HUT in patients with a history of syncope compared to those without it. However, there was no statistical difference between the groups (p = 0.1, Fisher s test).

Conclusion:
Neurocardiogenic syncopes were induced in 27% of patients with permanent AF, a figure consistent with the prevalence of permanent AF reported in the general population. Neurocardiogenic syncopes seem to be independent of the presence of the arrhythmia. There is no statistically higher risk of a positive HUT in patients with AF and a history of syncope.

Keywords: Atrial fibrillation; Neurocardiogenic syncope; Head-up tilt test

Published: March 1, 2007  Show citation