Tilt-testing reveals a susceptibility to reflex hypotension rather than distinguishing vasovagal from other causes of syncope, guiding management such as pacemaker therapy.
What is the clinical utility of tilt-testing in patients with syncope?
Tilt-testing should be reinterpreted as a measure of susceptibility to reflex hypotension rather than a specific diagnostic test for vasovagal syncope, which has implications for guiding pacemaker therapy.
There is growing scepticism over utility of tilt-testing for syncope diagnosis, which has been shown unable to distinguish vasovagal from other syncope, especially cardiac, despite its acceptable sensitivity and specificity in true positive and negative subjects. The new interpretation is that the test reveals a susceptibility to reflex hypotension, which may exist in coincidence with any cause of syncope. This implies an important change in patient management including selecting effective therapy, in particular in guiding pacemaker therapy in patients affected by reflex syncope.
Sutton et al. (Mon,) conducted a review in Syncope. Tilt-testing was evaluated. Tilt-testing reveals a susceptibility to reflex hypotension rather than distinguishing vasovagal from other causes of syncope, guiding management such as pacemaker therapy.