Minireviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Mar 26, 2016; 8(3): 277-282
Published online Mar 26, 2016. doi: 10.4330/wjc.v8.i3.277
Tilt table test today - state of the art
Nicholay Teodorovich, Moshe Swissa
Nicholay Teodorovich, Moshe Swissa, Kaplan Medical Center, the Hebrew University, Jerusalem 91120, Israel
Author contributions: Teodorovich N and Swissa M equally contributed to the article.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Moshe Swissa, MD, Kaplan Medical Center, the Hebrew University, P.O. Box 1, Rehovot 76100, Jerusalem 91120, Israel. swissam@mail.huji.ac.il
Telephone: +972-8-9441376 Fax: +972-8-9441110
Received: May 28, 2015
Peer-review started: May 31, 2015
First decision: August 16, 2015
Revised: September 3, 2015
Accepted: December 17, 2015
Article in press: December 18, 2015
Published online: March 26, 2016
Processing time: 298 Days and 16.9 Hours
Abstract

A tilt table test (TTT) is an inexpensive, noninvasive tool for the differential diagnosis of syncope and orthostatic intolerance and has good diagnostic yield. The autonomic system malfunction which underlines the reflex syncope is manifested as either hypotension or bradycardia, while an orthostatic challenge is applied. The timing of the response to the orthostatic challenge, as well as the predominant component of the response help to differentiate between various forms of neurocardiogenic syncope, orthostatic hypotension and non-cardiovascular conditions (e.g., pseudosyncope). Medications, such as isoproterenol and nitrates, may increase TTT sensitivity. Sublingual nitrates are easiest to administer without the need of venous access. TTT can be combined with carotid sinus massage to evaluate carotid sinus hypersensitivity, which may not be present in supine position. TTT is not useful to access the response to treatment. Recently, implantable loop recorders (ILR) have been used to document cardioinhibitory reflex syncope, because pacemakers are beneficial in many of these patients, especially those over 45 years of age. The stepwise use of both TTT and ILR is a promising approach in these patients. Recently, TTT has been used for indications other than syncope, such as assessment of autonomic function in Parkinson’s disease and its differentiation from multiple system atrophy.

Keywords: Syncope; Orthostatic intolerance; Tilt table test; Hypotension; Bradycardia

Core tip: A tilt table test (TTT) is a noninvasive tool for the differential diagnosis of syncope and orthostatic intolerance. The way of the response to the orthostatic challenge helps to differentiate between various forms of neurocardiogenic syncope, orthostatic hypotension and non-cardiovascular conditions. TTT can be combined with carotid sinus massage to evaluate carotid sinus hypersensitivity, which may not be present in supine position. Implantable loop recorders (ILR) have been used to document cardioinhibitory reflex syncope. The stepwise use of both TTT and ILR is a promising approach. TTT has been used to assessment of autonomic function in Parkinson’s disease.