Key result
Twelve-lead ECG during tilt table testing unmasks ectopic atrial tachycardia mimicking POTS.
Why the study?
Tilt table testing is typically performed with three-lead ECG monitoring, which limits P-wave interpretation when evaluating orthostatic intolerance and syncope.
Case Report (n=1)
No
Incorporating 12-lead ECGs during tilt table testing enables accurate localization of atrial arrhythmias and prevents misdiagnosis of orthostatic syndromes like POTS.
Limited-lead ECG during tilt testing risks missing atrial tachycardias mimicking POTS; this case leaves open whether routine 12-lead use improves diagnosis.
BACKGROUND: Tilt table testing is commonly used to evaluate orthostatic intolerance and syncope and is typically performed with three-lead electrocardiography (ECG) monitoring, which limits P-wave interpretation. CASE SUMMARY: A 21-year-old woman with congenitally corrected transposition of the great arteries presented with recurrent tachy-palpitations and near syncope and was presumed to have postural tachycardia syndrome (POTS) after extensive noninvasive testing. During head-up tilt table testing incorporating intermittent 12-lead ECGs, she developed a sustained narrow-complex tachycardia that reproduced her symptoms. Careful P-wave analysis demonstrated P-wave morphologies that localized the rhythm to a left atrial focus, which was later confirmed on an electrophysiology study. DISCUSSION: This case highlights the diagnostic value of 12-lead ECGs during tilt table testing for the analysis of P-wave morphology and axis. Ectopic atrial tachycardia may mimic orthostatic syndromes and remain undetected with limited-lead testing. TAKE-HOME MESSAGE: Incorporation of 12-lead ECGs during tilt table testing enables ECG-based localization of atrial arrhythmias, preventing misdiagnosis of orthostatic syndromes.
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Ramonfaur et al. (2026) conducted a case report in Presumed postural tachycardia syndrome (POTS) (n=1). 12-lead ECG during tilt table testing was evaluated on Arrhythmia mechanism diagnosis. The use of a 12-lead ECG during tilt table testing localized an ectopic atrial tachycardia that clinically mimicked postural tachycardia syndrome.
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