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71 patients with recurrent syncope which remained unexplained after standard clinical and electrophysiological investigation underwent 60 degree head-up tilt.This procedure reproduced symptoms with vasovagal syncope in 53(74%),40 of whom had bradycardia,some with prolonged asystole,during syncope.The other 13 patients had predominant vasodepression with hypotension.Mean time to syncope after tilt was 25 min.Patients with conduction tissue disease and age-matched control subjects had a 15%and 7%incidence of tilt syncope,respectively.Temporary dual-chamber pacing aborted syncope in 85%of subjects,and improved cardiac index and systemic blood pressure during tilt.Long-term results indicate that selected patients may benefit from permanent dual-chamber pacing. Head-up tilt is useful in the investigation of unexplained syncope because symptoms are reproduced in front of a medical witness. |
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