Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness
Clinical Autonomic Research, vol. 31, pp. 369–384
Abstract
Abstract 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.
Authors 15
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Leiden University · Leiden University Medical Center · Stichting Epilepsie Instellingen Nederland
Affiliation as printed
Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands. r.d.thijs@lumc.nl
Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands. r.d.thijs@lumc.nl
Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
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Presidio Ospedaliero · IRCCS Istituto Auxologico Italiano
Affiliation as printed
Department of Cardiology and Arrhythmologic Centre, Ospedali del Tigullio, 16033, Lavagna, Italy
Faint and Fall Programme, Department of Cardiology, Ospedale San Luca, IRCCS Istituto Auxologico Italiano, Milan, Italy
Department of Cardiology and Arrhythmologic Centre, Ospedali del Tigullio, Lavagna, Italy
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Transylvania University of Brașov
Affiliation as printed
Department of Neurology, County Emergency Clinic Hospital, Transilvania University, Brasov, Romania
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Innsbruck Medical University · Universität Innsbruck
Affiliation as printed
Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Beth Israel Deaconess Medical Center · Harvard University
Affiliation as printed
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
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Istituto delle Scienze Neurologiche di Bologna
Affiliation as printed
IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
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University of Cologne · Deutsches Zentrum für Luft- und Raumfahrt e. V. (DLR)
Affiliation as printed
Chair of Aerospace Medicine, University of Cologne, Cologne, Germany
German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
University Hypertension Center, Cologne, Germany
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University Hospital Centre Zagreb · University of Zagreb
Affiliation as printed
Referral Center for Autonomic Nervous System, Department of Neurology, School of Medicine, University Hospital Center Zagreb, University of Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
Referral Center for Autonomic Nervous System, Department of Neurology, School of Medicine, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
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Friedrich-Alexander-Universität Erlangen-Nürnberg · Icahn School of Medicine at Mount Sinai
Affiliation as printed
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Department of Neurology, University Erlangen-Nuremberg, Erlangen, Germany
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
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Affiliation as printed
Neurology Department, French Reference Center for MSA, University Hospital of Toulouse and INSERM U 1048, Toulouse, France
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University of Belgrade · Univerzitetski Klinički Centar Srbije
Affiliation as printed
Clinical Center of Serbia, Neurology Clinic, University of Belgrade, Belgrade, Serbia
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Universitätsklinikum Tulln · Karl Landsteiner University of Health Sciences
Affiliation as printed
Department of Neurology, University Clinic Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
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Affiliation as printed
Department of Cardiology, National Heart and Lung Institute, Hammersmith Hospital, Ducane Road, London, W12 0NN, UK
Department of Cardiology, National Heart and Lung Institute, Hammersmith Hospital, London, UK
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Innsbruck Medical University · Universität Innsbruck
Affiliation as printed
Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
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