Journal Article

‘The Italian Protocol’: a simplified head-up tilt testing potentiated with oral nitroglycerin to assess patients with unexplained syncope

A. Bartoletti, P. Alboni, F. Ammirati, M. Brignole, A. Del Rosso, G. Foglia Manzillo, C. Menozzi, A. Raviele and R. Sutton

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 2, issue 4, pages 339-342
Published in print October 2000 | ISSN: 1099-5129
Published online October 2000 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1053/eupc.2000.0125
‘The Italian Protocol’: a simplified head-up tilt testing potentiated with oral nitroglycerin to assess patients with unexplained syncope

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Head-up tilt testing potentiated by sublingual nitroglycerin (NTG), advocated by an Italian group, is a simple and safe but still not a standardized, diagnostic tool for the investigation of syncope. In fact, owing to its rapid spread, the original protocol received, often arbitrarily, many subsequent modifications. We now define the best methodology of the test on strictly evidence-based criteria as: stabilization phase of 5 min in the supine position;passive phase of 20 min at a tilt angle of 60 degrees;provocation phase of further 15 min after 400 μg NTG sublingual spray. Test interruption is made when the protocol is completed in the absence of symptoms, or there is occurrence of syncope, or occurrence of progressive (>5 min) orthostatic hypotension. We intend that this protocol, named by us as ‘The Italian Protocol’, will be accepted as the standard methodology of the tilt test potentiated by sublingual nitrates.

Keywords: Syncope; tilt testing; nitrates

Journal Article.  0 words. 

Subjects: Cardiovascular Medicine

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