Tilt-table testing: down but not out

Clin. Pract. (2014) 11(3), 265–268 ISSN 2044-9038 part of Syncope is very common, with the overall incidence for first syncope being 6.2 per 1000 patient years, increasing to 20 in females aged over 80 years [1]. Vasovagal syncope (VVS) is by far the most common cause, explaining over 20% of cases, with an underlying cardiac cause in 10% of cases and up to 37% of cases remaining unexplained [1]. The importance of syncope cannot be understated. It can have a negative impact upon education, physical activity and leisure, but can also result in loss of employment, driving restrictions, social isolation, falls and significant injury. Vasovagal syncope aside, cardiac and unexplained syncope are also associated with an increased mortality, necessitating accurate diagnosis [1]. The increase in morbidity and mortality is one of the driving forces behind the development of international guidelines and the creation of specialist syncope clinics. When the European Society of Cardiology Practice Guideline is applied in a specialist syncope setting the rate of undiagnosed syncope decreases from 37 to 10% [2,3]. Moreover, specialist syncope clinics reduce hospital readmission, reduce inappropriate use of investigations and reduce healthcare costs [4]. At the heart of these specialist clinics is the tilt table.