• Evaluation of syncope of uncertain origin.

• Evaluation of symptoms suggestive of autonomic dysfunction, such as

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  • Presyncope.

  
  

  • Atypical seizures.

  
  

  • Orthostatic symptoms.

• Distinguish between psychosomatic and neurally mediated symptoms.

• Complete heart block or profound bradycardia at rest.

• Significant left or right ventricular outflow obstructive lesions.

• Generally not performed in patients with structural heart disease and syncope, unless all other testing, including invasive electrophysiology testing, is unrevealing.

• Tilt table: Motor-driven table, capable of 70-degree upright positioning.

• Monitoring for continuous heart rate and blood pressure recording.

• Intravenous access.

• Resuscitation equipment, including medications and cardiac defibrillator.

• Prolonged asystole.

• Hypotension.

• Seizures.

• Cardiac arrest (very rare).

• Most episodes of vasovagal or neurally mediated syncope can be elucidated by careful history of the events surrounding clinical episodes.

• Tilt-table testing does not provide additional useful information for most straightforward cases of vasovagal syncope.

• Tilt-table testing is helpful in the following settings:

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  • Recurrent syncope of uncertain etiology.

  
  

  • Syncope without prodromal symptoms.

  
  

  • Patients with normal electroencephalogram and a diagnosis of a seizure disorder.

  
  

  • Symptoms occurring while standing.

• Patients with syncope should have an ECG performed to exclude possibility of long QT syndrome.