Evaluating unexplained syncope with upright tilt testing

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Trials of upright tilt testing for vasovagal syncope are difficult to evaluate, owing to differing methods used and the lack of a gold standard with which to compare this test. This paper reviews the studies to date and offers recommendations for the clinical use of this test.


Upright tilt testing is performed either alone (“passive testing”) or with isoproterenol infusion. Few comparative studies have been performed, but the rate of positive responses appears similar with both types of testing using the same angle of tilt, while the specificity is better with passive testing. At present, tilt testing should be performed only in patients with recurrent and disabling syncope in whom standard testing has failed to disclose a cause and in whom a positive result would help in devising a treatment plan. Patients with heart disease and arrhythmias should be carefully evaluated for arrhythmias before considering tilt testing. Controlled trials of therapy for vasovagal syncope have not yet been done. Treatment is reserved for patients with disabling symptoms.



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