Tilt table testing, methodology and practical insights for the clinic
van Zanten, Steven ; Sutton, Richard LU ; Hamrefors, Viktor LU
; Fedorowski, Artur
LU
and de Lange, Frederik J
(2023)
In Clinical Physiology and Functional Imaging
p.1-12
- Abstract
Tilt table testing (TTT) has been used for decades to study short-term blood pressure (BP) and heart rate regulation during orthostatic challenges. TTT provokes vasovagal reflex in many syncope patients as a background of widespread use. Despite the availability of evidence-based practice syncope guidelines, proper application and interpretation of TTT in the day-to-day care of syncope patients remain challenging. In this review, we offer practical information on what is needed to perform TTT, how results should be interpreted including the Vasovagal Syncope International Study classification, why syncope induction on TTT is necessary in patients with unexplained syncope and on indications for TTT in syncope patient care. The minimum... (More)
Tilt table testing (TTT) has been used for decades to study short-term blood pressure (BP) and heart rate regulation during orthostatic challenges. TTT provokes vasovagal reflex in many syncope patients as a background of widespread use. Despite the availability of evidence-based practice syncope guidelines, proper application and interpretation of TTT in the day-to-day care of syncope patients remain challenging. In this review, we offer practical information on what is needed to perform TTT, how results should be interpreted including the Vasovagal Syncope International Study classification, why syncope induction on TTT is necessary in patients with unexplained syncope and on indications for TTT in syncope patient care. The minimum requirements to perform TTT are a tilt table with an appropriate tilt-down time, a continuous beat-to-beat BP monitor with at least three electrocardiogram leads and trained staff. We emphasize that TTT remains a valuable asset that adds to history building but cannot replace it, and highlight the importance of recognition when TTT is abnormal even without syncope. Acknowledgement by the patient/eyewitness of the reproducibility of the induced attack is mandatory in concluding a diagnosis. TTT may be indicated when the initial syncope evaluation does not yield a certain, highly likely, or possible diagnosis, but raises clinical suspicion of (1) reflex syncope, (2) orthostatic hypotension (OH), (3) postural orthostatic tachycardia syndrome or (4) psychogenic pseudosyncope. A therapeutic indication for TTT in the patient with a certain, highly likely or possible diagnosis of reflex syncope, may be to educate patients on prodromes. In patients with reflex syncope with OH TTT can be therapeutic to recognize hypotensive symptoms causing near-syncope to perform physical countermanoeuvres for syncope prevention (biofeedback). Detection of hypotensive susceptibility requiring therapy is of special value.
(Less)
- author
- van Zanten, Steven
; Sutton, Richard
LU
; Hamrefors, Viktor
LU
; Fedorowski, Artur
LU
and de Lange, Frederik J
- organization
- publishing date
- 2023-10-15
- type
- Contribution to journal
- publication status
- epub
- subject
- in
- Clinical Physiology and Functional Imaging
- pages
- 1 - 12
- publisher
- John Wiley & Sons Inc.
- external identifiers
-
- scopus:85174207354
- pmid:37839043
- ISSN
- 1475-0961
- DOI
- 10.1111/cpf.12859
- language
- English
- LU publication?
- yes
- additional info
- © 2023 The Authors. Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine.
- id
- 53f59915-b0f6-4133-91b5-67feb1b3be5e
- date added to LUP
- 2023-10-16 14:31:42
- date last changed
- 2024-04-25 21:33:28
@article{53f59915-b0f6-4133-91b5-67feb1b3be5e,
abstract = {{<p>Tilt table testing (TTT) has been used for decades to study short-term blood pressure (BP) and heart rate regulation during orthostatic challenges. TTT provokes vasovagal reflex in many syncope patients as a background of widespread use. Despite the availability of evidence-based practice syncope guidelines, proper application and interpretation of TTT in the day-to-day care of syncope patients remain challenging. In this review, we offer practical information on what is needed to perform TTT, how results should be interpreted including the Vasovagal Syncope International Study classification, why syncope induction on TTT is necessary in patients with unexplained syncope and on indications for TTT in syncope patient care. The minimum requirements to perform TTT are a tilt table with an appropriate tilt-down time, a continuous beat-to-beat BP monitor with at least three electrocardiogram leads and trained staff. We emphasize that TTT remains a valuable asset that adds to history building but cannot replace it, and highlight the importance of recognition when TTT is abnormal even without syncope. Acknowledgement by the patient/eyewitness of the reproducibility of the induced attack is mandatory in concluding a diagnosis. TTT may be indicated when the initial syncope evaluation does not yield a certain, highly likely, or possible diagnosis, but raises clinical suspicion of (1) reflex syncope, (2) orthostatic hypotension (OH), (3) postural orthostatic tachycardia syndrome or (4) psychogenic pseudosyncope. A therapeutic indication for TTT in the patient with a certain, highly likely or possible diagnosis of reflex syncope, may be to educate patients on prodromes. In patients with reflex syncope with OH TTT can be therapeutic to recognize hypotensive symptoms causing near-syncope to perform physical countermanoeuvres for syncope prevention (biofeedback). Detection of hypotensive susceptibility requiring therapy is of special value.</p>}},
author = {{van Zanten, Steven and Sutton, Richard and Hamrefors, Viktor and Fedorowski, Artur and de Lange, Frederik J}},
issn = {{1475-0961}},
language = {{eng}},
month = {{10}},
pages = {{1--12}},
publisher = {{John Wiley & Sons Inc.}},
series = {{Clinical Physiology and Functional Imaging}},
title = {{Tilt table testing, methodology and practical insights for the clinic}},
url = {{http://dx.doi.org/10.1111/cpf.12859}},
doi = {{10.1111/cpf.12859}},
year = {{2023}},
}