title: Significance of tilt table testing in patients with suspected arrhythmic syncope and negative electrophysiologic study.
abstract: BACKGROUND
  The diagnostic significance of a tilt table test (TTT) in patients with a suspected arrhythmic etiology for syncope and negative electrophysiologic study (EPS) has not been previously assessed comparing the TTT results with the findings of prolonged monitoring using an implantable loop recorder (ILR). We sought to assess the diagnostic yielding of TTT in patients with suspected arrhythmic syncope and negative EPS.
  
  
  RESULTS
  In 81 patients with suspected arrhythmic etiology for syncope and negative EPS, TTT was performed and an ILR implanted regardless the results of TTT. TTT was positive in 38 patients. During follow-up, syncope or presyncope recurred in 32 patients (39.5%). No differences were found in recurrence rates in patients with positive and negative TTT (31.5% vs 46.5%, P = ns). According to rhythm registered during ILR activation, mechanisms of syncopal events were classified as: arrhythmic (atrioventricular [AV] block and ventricular tachycardia; n = 18), neurally mediated (sinus bradycardia and sinus pause; n = 9), and indeterminate (normal sinus rhythm; n = 5). There was no statistical association between the results of TTT and the mechanism of syncope.
  
  
  CONCLUSIONS
  In patients with a suspected arrhythmic etiology for syncope and a negative EPS, TTT is of little value to predict the mechanism of syncope and the ILR implantation seems to be a useful and safe diagnostic strategy.
authors.affiliation: Department of Cardiology, Hospital Clinico Universitario, Valencia, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: García-Civera
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ruiz-Granell
authors.forename: Salvador
authors.initials: S
authors.lastname: Morell-Cabedo
authors.forename: Rafael
authors.initials: R
authors.lastname: Sanjuan-Mañez
authors.forename: Angel
authors.initials: A
authors.lastname: Ferrero
authors.forename: Angel
authors.initials: A
authors.lastname: Martínez-Brotons
authors.forename: Araceli
authors.initials: A
authors.lastname: Roselló
authors.forename: Segismundo
authors.initials: S
authors.lastname: Botella
authors.forename: Angel
authors.initials: A
authors.lastname: Llacer
mesh_terms: D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000453:epidemiology*; D015897:Comorbidity; D004562:Electrocardiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013030:Spain / Q000453:epidemiology; D013575:Syncope / Q000175:diagnosis* / Q000453:epidemiology*; D018667:Tilt-Table Test / Q000706:statistics & numerical data*