Performing Tilt Testing and Physical Countermaneuvers Training

Abstract

Vasovagal syncope is a common clinical condition and has an estimated lifetime prevalence of 35% [1]–[3]. Although the disorder is episodic in nature, it can be considered a chronic disorder since symptoms often occur over many years due to recurrent episodes of (pre)syncope [1, 2], with deleterious effects on patients’ quality of life [4]. A correct initial evaluation (history, physical examination, supine and upright systolic blood pressure measurement, ECG) in accordance with European Society of Cardiology Syncope Guidelines [5] facilitates a diagnosis of suspected or certain neurally mediated syncope. In this case, additional, specific diagnostic tests should be performed. Different diagnostic examinations are used in actual clinical practice to identify the syncope mechanism. These include carotid sinus massage (CSM), tilt-table testing, and implantable loop recorder. In patients > 40 years of age, CSM can identify an abnormal response. This so-called carotid sinus hypersensitivity is characterized by a ventricular pause lasting ≥ 3 s and a fall in systolic blood pressure of ≥ 50 mmHg. However, carotid sinus hypersensitivity is not diagnostic of carotid sinus syndrome (CSS); rather, reproducibility is a crucial diagnostic element. If the latter is to be obtained, the patient should undergo tilt-table testing under secure conditions in order to prevent his or her injury from a fall.