The Effect of Clinical Triggers on Positive Responses to Tilt-Table Testing Potentiated with Nitroglycerin or Clomipramine

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Objectives: We evaluated the effect of clinical triggers on tilt-table testing (TTT) potentiated with nitroglycerin (which acts through peripheral dilatation) or clomipramine (which acts through a central serotoninergic mechanism). Background: The effect of clinical triggers on TTT responses has not been systematically evaluated. Methods: We enrolled 66 patients triggered by emotional distress (central trigger), 161 by specific situations or by prolonged standing (peripheral trigger), and 153 syncope occurred in the absence of any detectable trigger. Nitro-TTT performed in 252 patients and Clomipramine-TTT performed in 128 patients, consisted of 20 min of tilting with intravenous administration of 5 mg Clomipramine during the first 5 min. Results: The positivity of Nitro-TTT was greater in patients with clinical triggers (71% central, 75% peripheral) than in those without (36%). On Clomipramine-TTT, the positivity rate was higher in patients with central triggers (92%) than in those with peripheral (45%) and no triggers (30%). The cardioinhibitory form was more frequent in patients with a central trigger than in the other two groups (34% versus 12% and 7%) and with Clomipramine-TTT than with Nitro-TTT (19% vs 11%). Conclusion: The presence of clinical triggers increases the positivity of TTT and influences the type of response. Some specificity of nitroglycerin and clomipramine for peripheral and central mechanisms exists.