The upright tilt table test is commonly performed for the evaluation of syncope although the test has limited specificity, sensitivity, and reproducibility. It may be helpful particularly in young, otherwise healthy patients in whom the diagnosis of vasovagal (neurocardiogenic) syncope is suspected but not certain [1-3]. It is also useful in older persons in whom the cause of syncope remains unclear, but vasovagal syncope is suspected [3,4].
The utility of and protocol for tilt table testing will be reviewed here. The general evaluation of the patient with syncope and vasovagal syncope and other types of reflex (neurally-mediated) syncope is discussed separately. (See "Evaluation of syncope in adults" and "Reflex syncope".)
We agree with the 2009 ESC indications for upright tilt table testing in the following clinical settings :
- Recurrent episodes of syncope in the absence of organic heart disease, or in the presence of organic heart disease after cardiac causes of syncope have been excluded.
- Unexplained single syncopal episode in high risk settings (eg, occurrence or potential risk for physical injury or occupational hazard).
- When deemed of clinical value to demonstrate susceptibility to reflex syncope to the patient. (See "Reflex syncope", section on 'Upright tilt table test'.)
Tilt testing is reasonable to discriminate between reflex and orthostatic hypotension syncope . (See "Reflex syncope".)