I recently had a Tilt Table Test that resulted in asystole for over 60 seconds requiring chest compressions. Impression: Positive head up tilt test for vasodepression and cardioinhibitory response consistent with neurocardiogenic syncope. Two questions, is 60 second asystole unusual for HUTTT and was this potentially life threatening and two, can we assume that future syncope incidents could have resulted in similar asystole? Previous syncope had resulted in concussions and broken bones with no warnings before falling. I now have a dual lead pacemaker, will that be sufficient to prevent future episodes?
It is not unusual for a tilt table test, as that is exactly what the test is looking to detect. It's not that syncope is causing the asystole, but vice versa. Basically, your vagal nerve is overactive and causes pauses in your heart beat, resulting in temporarily decreased brain perfusion causing you to faint. When you faint, you take on a horizontal position, which allows gravity to help perfuse the brain and end the cycle.
A permanent pacemaker is exactly the right treatment, and will not allow you to have long pauses, thereby attenuating the syncopal episodes.
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