The Tilt Test in the Assessment of Syncope and Pre-syncope. Effective and safe? Analysis of a Series of 2364 Patients over 6 Years

The tilt table test (TT) provides relevant information about individual susceptibility to neuro-mediated hypotension and bradycardia. Its importance has been questioned. In this work, we analyze the results and safety of TT in the investigation of syncope, presyncope or postural dizziness. Cross-sectional study, with TT exams performed by specialists in cardiac arrhythmias, in the period 2016-2021, in a syncope unit. Analyzes were performed using the Mann-Whitney test, multiple logistic regression, with a significant p value <0.05. The protocols used were Westminster or Italian protocol. There were 2364 TT performed, 61.7% female, aged 51.1 (31-71) years. The positivity rate was 32.6%, 37.2% with pharmacological sensitization (p< 0.01). For the investigation of syncope, positivity was 34.2% (477) x 30.65% (285) for other symptoms (p<0.001), while evaluating syncope and presyncope together the difference was 37.55% (623) x 20.9% (139) for other symptoms (p<0.001). Positivity was higher in males (p<0.01; OR=1.40(1.16-1.69)), in sensitized tests (p<0.01;2.01(1.64-2, 38)), in patients with early orthostatic hypotension (OH) with symptoms (p <0.01; 9.68(4.13-27.44)). The complication rate was 3.29%, but without severity. The TT remains an important and safe methodology in clinical practice for the investigation of patients with suspected neurally mediated syndromes.