Differences in heart rate variability between cardioinhibitory and vasodepressor responses to Head-Up tilt table testing

RESUMO

Background. Patients with syncope show different responses to head-up tilt (HUT) test, which may be due to different pathophysiological mechanisms. Methods. HUT (70º) was perfumed in 24 patients who experienced recurrent syncope. Nine patients had a cardioinhibitory (CI) response, 7 patients had a vasodepressor (VD) response, and 8 patients had a mixed (MX) response. Heart rate variability was analysed at 60-sec periods during HUT Results. Total spectrum (TS) was greater at rest and 1 min after syncope in the CI and MX groups as compared to the VD group. Low frequency spectrum (LF) was significantly greater during rest and the first minute after syncope in the CI groups as compared with the VD group. After the rest period, the CI and MX groups showed more elevated high frequency spectrum (HF) values than the VD group (p <0.01). One minute after syncope, the HF increased in the CI and MX groups but not in the VD group (p < 0.01). The VD group showed higher LF/HF ratio from the beginning of rest (3.9 ñ 4.1) as compared to the CI and MX groups (p <0.01). This differnce was most significant 2 min before syncope occurred. The CI and MX groups showed greater pNN50 and rMSSD as compared to the VD group. Conclusions. Our results suggest that vagal tone is higher in subjects showing cardioinhibitory and mixed responses to HUT. In contrast, patients with a vasodepressor response showed predominanty sympathetic activity. These findings suggest that there are differ ent pathophysiological mechanisms underlyng syncope