Authors

• Lada Bradić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-8296-699X
• Marina Mihajlović — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-0027-9676
• Arijana Crevar — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-3585-727X
• Gregor Eder — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-5495-7789
• Kristina Krželj — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-2269-3138
• Tena Jukić — University Hospital Centre Zagreb, Zagreb, Croatia
• Ivan Bitunjac — General Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia — ORCID: 0000-0002-4396-6628
• Martina Lovrić Benčić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-8446-6120

Abstract

**Introduction**: Syncope is defined as transient, self-limited loss of consciousness due to temporary global cerebral hypoperfusion, resulting from low peripheral resistance and/or low cardiac output (1). Reported incidence of syncope is high; 18-40 per 1,000 patient-years in general population (2). Tilt-table testing enables reproduction and characterization of syncope in controlled settings, according to blood pressure and heart rate response to tilting. Modified VASIS classification to tilt testing distinguishes: reflex/vasodepressor syncope, cardioinhibitory syncope with/without asystole, mixed syncope, orthostatic hypotension and POTS (postural orthostatic tachycardia syndrome) (3). **Patients and Methods**: We retrospectively analyzed 708 patients (67% female, 33% male) who underwent tilt-table testing in our institution from 2013 to September 2017. Of the referred patients 47.6% were 15-30 y/o, 29.8% were 30-60 y/o, and 22.6% were >60 y/o. Patient history included syncope in majority of patients - 84.6%, 80.1% and 68.8% of patients 60 y/o, respectively. **Results**: Normal reaction to tilt-up testing was found in 49.3% of young (60 y/o). Tilt-up testing provoked syncope in 32.6% of patients 60 y/o (p60 y/o, p60 y/o) patients, p83% of elderly patients had normal reaction to testing, thus questioning widespread use of tilt-table testing in this age group. Mechanisms underlying syncope should be sought in order to properly diagnose and counsel patients for syncope avoidance. Only a minority of younger patients had cardioinhibitory syncope, and none during four analyzed years required pacemaker implantation. Elderly patients with syncope should be evaluated using alternative diagnostic algorithms.

Keywords

tilt-table test, syncope, transient loss of consciousness

DOI

Literature

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3. Simova I. Role of tilt-table testing in syncope diagnosis and management. E-journal of the ESC Council for the Cardiology Practice. 2015 Nov;35(13). Available at: (22.9.2017). https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-13/role-of-tilt-table-testing-in-syncope-diagnosis-and-management