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Comparison of Trinitroglycerin and Adenosine As Provocative Agents for Head-Up Tilt Test in Patients With Unexplained Syncope: A Semi-Crossover Randomized Clinical Trial With Prospective Follow-Up Publisher Pubmed



Tajdini M1 ; Aminorroaya A2, 3 ; Rahimi B4 ; Mortazavi SH1 ; Vasheghani Farahani A1 ; Sadeghian S1 ; Easapour Moghadam M1 ; Soltani D1 ; Bozorgi A1
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Source: Journal of Interventional Cardiac Electrophysiology Published:2021


Abstract

Purpose: Head-up tilt test (HUTT) is a reasonable diagnostic evaluation for patients with suspected vasovagal syncope; however, its lengthy duration is a remarkable limitation. Although adenosine (AD), as an alternative provocative agent, is a promising option for tackling this shortcoming, it received little appreciation in the literature. We aimed to compare the efficacy and the time to elicit a positive response to HUTT for sublingual trinitroglycerin (TNG) and intravenous AD. Furthermore, we evaluated patients’ outcomes in the follow-up. Methods: Patients with a chief complaint of transient loss of consciousness (TLOC) were evaluated. We randomized patients with the diagnosis of unexplained syncope after diagnostic evaluations, to undergo TNG-augmented HUTT or AD-augmented HUTT. They were crossed over to receive the other medication in case of negative response to the test. In the follow-up, we evaluated traumatic and non-traumatic TLOCs, hospitalization due to syncope, and death in patients. Results: We randomized 132 patients (41.70 ± 19.37 years, 52.3% female) to receive TNG (n = 66) or AD (n = 66). Respectively, the positivity rate of TNG and AD for the first and the crossover-HUTT was 31.1% and 26.7%, and 20.5% and 26.2% with no statistically significant differences in both tests (P ˃ 0.50). The time to positive response was significantly shorter for AD than TNG (P < 0.001). In the follow-up, re-admission was significantly more prevalent in HUTT-negative patients compared to HUTT-positive patients (P = 0.04). Conclusions: We found that diagnostic yield of TNG and AD in HUTT is comparable, while AD acts 4 times faster than TNG in evoking a vasovagal response. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.
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