The usefulness of tilt testing with an intravenous beta-blocker in assessing the efficacy of long-term therapy in patients with vasovagal syncope

Background: Although beta blockers are frequently used for the prevention of recurrences of vaso-vagal syncope, the prediction of the long-term efficacy of this treatment is difficult.Aim: To assess whether the result of tilt testing with an intravenous beta blocker can predict the long-term efficacy of beta blockade.Methods: The study group consisted of 62 patients (29 females, mean age 32.8±12.3 years and 33 males, mean age 35.9±18.2 years) with at least two syncopal episodes during the six months preceding positive tilt testing. After baseline tilt test, propranolol in a dose of 0.1 mg/kg body weight was administered intravenously and the tilt test was repeated. Beta blockade was defined effective if the second tilt test was negative (complete efficacy) or the time to syncope during tilt testing was increased compared with the baseline tilting (partial efficacy). All patients received chronic propranolol treatment and were followed for one year or till the recurrence of syncope.Results: Intravenous propranolol prevented (n=33) or delayed (n=18) syncope during tilt testing in 51 (82%) patients whereas it was ineffective in the remaining 11 (18%) patients. During 8.6±6.7 (range 1-14) months of follow-up, 20 (32%) patients had syncope recurrence; 13 (25%) from the group with effective intravenous propranolol versus 7 (64%) patients in whom intravenous propranolol did not prevent syncope during tilt testing (