LAUSR

Introduction The objective of this study was to evaluate safety of autonomic testing and skin biopsies. Methods This was a retrospective study which reviewed review electronic records of patients referred for autonomic testing for events at Brigham and Women’s Faulkner Hospital (BWFH). Results 630 patients were reviewed. Emergency alert code has been initiated 3 times. One code was later decided to be not necessary. Two codes were triggered because prolonged asystole which started during the tilt and in spite of immediate tilt termination, the asystole persisted in supine position (one subject for 12 s, another for 73 s). Both subjects had history of similar events and they fully recovered. The tilt malfunctioned in one patient as the patient developed vigorous psychogenic rhythmic whole body movement that temporarily disabled the electric tilt engine. Patient had to be removed from the tilt manually. Three patients became unresponsive during the tilt with stable heart rate, blood pressure and cerebral blood flow velocity which was consistent with psychogenic pseudosyncope. These patients responded to reassurance. Skin biopsy became infected requiring antibiotics in 2 subjects. Transient pain and redness at the biopsy site was reported in 7 subjects. Four patients (elevated blood pressure, n = 2, persistent dizziness and tiredness n = 1, asystolic syncope n = 1) were referred to emergency department after the autonomic testing. No admissions occurred because of autonomic testing complications. Some family members witnessed the events described above since at BWFH we have a policy that family member and/or patients friends are able to be present during the testing. Conclusion Autonomic testing and skin biopsies are safe. No chronic complications of testing occurred in our cohort. However, technicians and physicians conducting the testing have to be familiar with recognition and management of syncope, pseudosyncope and complications of skin biopsies. Since family members who are present during the testing may witness the syncope and related complications, sensitive approach and reassurance is recommended. Physician presence during the tilt test or a least during its substantial portion (first 3 min) is advised.