The Value of Tilt Testing and Autonomic Nervous System Assessment

Sutton, Richard

doi:10.1016/j.ccl.2015.04.003

Cited by 8 publications

(2 citation statements)

References 27 publications

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“…Several protocols for TTT have been reported with or without pharmacological challenges (Forleo et al, 2013;Sutton, 2015). The available evidence suggests that 30-60 min is optimal for the diagnosis of VVS (Brignole et al, 2018a;Saal et al, 2016;Forleo et al, 2013).…”

Section: Indication Reflex Syncopementioning

confidence: 99%

Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness : Consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN)

Thijs

Brignole

Falup‐Pecurariu

et al. 2021

Autonomic Neuroscience

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An expert committee was formed to reach consensus on the use of Tilt Table Testing (TTT) in the diagnosis of disorders that may cause transient loss of consciousness (TLOC) and to outline when other provocative cardiovascular autonomic tests are needed. While TTT adds to history taking, it cannot be a substitute for it. An abnormal TTT result is most meaningful if the provoked event is recognised by patients or eyewitnesses as similar to spontaneous ones. The minimum requirements to perform TTT are a tilt table, a continuous beat-to-beat blood pressure monitor, at least one ECG lead, protocols for the indications stated below and trained staff. This basic equipment lends itself to perform (1) additional provocation tests, such as the active standing test carotid sinus massage and autonomic function tests; (2) additional measurements, such as video, EEG, transcranial Doppler, ☆ Consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN). ☆☆ This article is co-published in the journals "Clinical Autonomic Research" and "Autonomic Neuroscience".

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Section: Indication Reflex Syncopementioning

confidence: 99%

Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness : Consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN)

Thijs

Brignole

Falup‐Pecurariu

et al. 2021

Autonomic Neuroscience

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“…Since then, it has propagated worldwide as a routine test to determine the cause of transient loss of consciousness. [3] Headupright tilt table testing has been used by physiologists and physicians to study hemodynamic and neuroendocrine responses in hemorrhage, congestive heart failure, autonomic dysfunction and hypertension; and drug research. [4] It allows reproduction of syncope with simultaneous monitoring of physiologic parameters.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic utility of the head-up tilt test in syncope and the related complications

Salwan¹,

Salwan²,

Wadhwa³

2017

Int. J. Adv. Res. Biol. Sci

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Background: Recurrent syncope is a distressing symptom in which the cause may remain undetermined. A definitive diagnosis may help the patients to lead a normal life and avoid the unnecessary risk to their lives. Objective: To evaluate the effectiveness and safety of Head up Tilt Test (HUTT) in patients with undiagnosed syncope and to detect and follow up any complications arising out of the procedure. Material and methods: The head up tilt table test was performed in department of cardiology. 72 patients with a history of syncope or presyncope underwent upright tilt table testing to exclude vasovagal syncope, with baseline tilt and if negative followed by progressively increasing doses of isoprenaline infusion. 70° tilt was used and continuous heart rate and non-invasive BP recordings were made every 2 minutes or earlier when symptomatic. Results: The mean age of the patients was 48±16 years. None of the patients had carotid sinus hypersensitivity. Forty-five patients (62.5%) were positive for syncope. Four (5.55 %) were positive during the baseline tilt and forty-one (56.9%) were positive with the use of isoprenaline during tilt. The majority of positive responses were mixed 23 (51.11%), 17(37.77%) were vasodepressor and 5(11.11%) were cardioinhibitory. The mean time to syncope was 31.84 ± 8.0 minutes. There was a mean drop of 55.65 mmHg in systolic blood pressure and 36.06 mmHg in diastolic blood pressure in the positive group (p = <0.001 for both).No statistical significance was observed as regards the age ,sex and type of response. No significant untoward incidents were noted except partial seizures in one patient. Conclusion:The head-up tilt test is a simple, non-invasive, relatively safe test which is useful in documenting objective measures of orthostatic hypotension that cannot be obtained in a clinical setting.

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Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness

et al. 2021

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An expert committee was formed to reach consensus on the use of tilt table testing (TTT) in the diagnosis of disorders that may cause transient loss of consciousness (TLOC) and to outline when other provocative cardiovascular autonomic tests are needed. While TTT adds to history taking, it cannot be a substitute for it. An abnormal TTT result is most meaningful if the provoked event is recognised by patients or eyewitnesses as similar to spontaneous events. The minimum requirements to perform TTT are a tilt table, a continuous beat-to-beat blood pressure monitor, at least one ECG lead, protocols for the indications stated below and trained staff. This basic equipment lends itself to the performance of (1) additional provocation tests, such as the active standing test, carotid sinus massage and autonomic function tests; (2) additional measurements, such as video, EEG, transcranial Doppler, NIRS, end-tidal CO2 or neuro-endocrine tests; and (3) tailor-made provocation procedures in those with a specific and consistent trigger of TLOC. TTT and other provocative cardiovascular autonomic tests are indicated if the initial evaluation does not yield a definite or highly likely diagnosis, but raises a suspicion of (1) reflex syncope, (2) the three forms of orthostatic hypotension (OH), i.e. initial, classic and delayed OH, as well as delayed orthostatic blood pressure recovery, (3) postural orthostatic tachycardia syndrome or (4) psychogenic pseudosyncope. A therapeutic indication for TTT is to teach patients with reflex syncope and OH to recognise hypotensive symptoms and to perform physical counter manoeuvres.

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The Value of Tilt Testing and Autonomic Nervous System Assessment

Cited by 8 publications

References 27 publications

Diagnostic utility of the head-up tilt test in syncope and the related complications

Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness

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