Role of head-up tilt table testing in patients with syncope or transient loss of consciousness

The tilt table test (TTT) is a useful method for the management of reflex syncope. However, the TTT is incomplete and has several problems. The indications for this test are established using guidelines. The TTT is not suitable for all syncopal patients. It is currently unclear (1) When should the TTT be used, (2) for which types of patients TTT should be performed, and (3) does the TTT provide useful information to guide indication for pacing therapy for reflex syncope. The answers to these questions appear in recent reports from two guidelines published by the European Society of Cardiology and the Japan Circulation Society. The indications for TTT do not apply to all syncopal patients, but selected patients. For patients with low risks and rare syncopal events, the TTT is not necessary, even when diagnoses are unconfirmed. The TTT is used not only for diagnosis of reflex syncope, but also for many clinical management of several conditions (i.e., exclusion of cardiac syncope). Positive TTT results cannot predict the effects of pacing therapy for reflex syncope. The decision to use pacing therapy should be based on documented electrocardiograms and other findings, including TTT results.