Vasovagal Syncope: To Tilt or Not to Tilt?
Tilt testing for the investigation of the clinical problem of syncope was introduced in the mid 1980s [1,2]. It represented an advance in the approach to this clinical arena, which had always offered serious challenges to physicians, because it became possible to reproduce the patient’s symptoms in front of the clinician. Furthermore, this gave an opportunity for monitoring of many physiological variables allowing greater understanding of the mechanism of vasovagal syncope, if not its trigger. Syncope is an infrequent event for most sufferers, once per month can be considered often, implying that it is extremely difficult to observe an attack by any type of monitor. Herein lies the value of tilt testing but more than 10 years of clinical experience have placed its benefits in perspective and, as other clinical tests, it is not perfect.
KeywordsTilt Testing Vasovagal Syncope Tilt Table Testing Drug Challenge Unexplained Syncope
Unable to display preview. Download preview PDF.
- 7.Petersen MEV, Williams TR, Gordon C et al (1997) The normal response to prolonged passive head-up tilt testing. Heart (in press)Google Scholar
- 9.Sutton R, Petersen MEV (1995) Invasive tilt testing: the search for a new sensor to permit earlier pacing therapy in vasovagal syncope. In: Raviele A (ed) Cardiac Arrhythmias 1995. Springer-Verlag Italia, Milano, pp 132–133Google Scholar
- 10.Moya A, Permanyer-Miralda G, Sagrista-Sauleda J et al (1995) Limitations of head-up tilt test for evaluating the efficacy of therapeutic interventions in patients with vaso-vagal syncope: results of a controlled study of etilefrine versus placebo. J Am Coll Cardiol 25: 65–69PubMedCrossRefGoogle Scholar
- 11.VASIS Etilefrine study results to be published.Google Scholar
- 13.McIntosh S, Lawson J, da Costa D et al (1996) Use of sublingual glyceryl trinitrate during head-up tilt as a provocation test for vasovagal responses in elderly patients with unexplained syncope. Cardiol Elderly 4: 33–38Google Scholar
- 17.Grubb BP, Kosinski D, Pothoulakis A (1995) New and emerging indications for head-up tilt table testing. Eur J Card Pacing Electrophysiol 5: 109–112Google Scholar
- 18.Sutton R, Petersen MEV (1995) Expanding uses for tilt testing. Eur J Card Pacing Electrophysiol 5: 122–123Google Scholar