The Use of Head-up Tilt Testing in the Investigation of Syncope

Abstract The cause of syncope remains unknown in about 40% of cases after extensive investigations. Elderly patients are at increased risk of syncope because of the physiologic changes due to aging, higher incidence of chronic illness and the use of a greater number of medications that may contribute to hypotension. Syncope is common, difficult to evaluate and has a high morbidity and mortality. Head-up tilt-testing (HUT) has become an important part of the investigation of patients with recurrent unexplained syncope. There have been concerns about the specificity and the lack of standard methodology for tilt testing. The reproducibility of HUT is therefore open to question. The effectiveness of treatment is uncertain because of the paucity of randomised-controlled trials. Drug therapy should be tried in patients with recurrent syncope. The usefulness of cardiac pacing for treatment of recurrent vasovagal syncope remains incompletely understood. Further research is needed to define the pathophysiology and effective treatments of neurocardiogenic syncope.