RCT | Shortened head-up tilt test is non-inferior to traditional method for suspected vasovagal syncope

Summary: The randomized clinical trial compared a short-duration head-up tilt test (HUTT) with the traditional longer-duration test for diagnosing suspected vasovagal syncope (VVS). The study involved 554 patients, half of which underwent the Fast protocol and the other half the Traditional protocol. The Fast protocol consisted of a 10-minute passive phase followed by a 10-minute nitroglycerin (NTG) phase if the passive phase yielded negative results, while the Traditional protocol included a 20-minute passive phase and a 15-minute NTG phase.

The findings showed no significant difference in the diagnostic value between the two protocols. Positive responses, identified by syncope induction amid hypotension or bradycardia, were seen in 60.3% of patients in the Fast protocol and 58.5% in the Traditional. However, there was a trend of less vasodepressor response in the Fast protocol during the passive phase.

This study suggests that the Fast HUTT protocol could replace the Traditional one, reducing test duration from 40 to 25 minutes without compromising diagnostic efficacy. However, the research didn’t assess the specificity of the Fast HUTT protocol in patients without a history of syncope, which serves as a limitation.

Article: Short-duration head-up tilt test potentiated with sublingual nitroglycerin in suspected vasovagal syncope: the fast Italian protocol – European Heart Journal (free for a limited period)

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