Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness : Consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN)

Abstract

An expert committee was formed to reach consensus on the use of Tilt Table Testing (TTT) in the diagnosis of disorders that may cause transient loss of consciousness (TLOC) and to outline when other provocative cardiovascular autonomic tests are needed. While TTT adds to history taking, it cannot be a substitute for it. An abnormal TTT result is most meaningful if the provoked event is recognised by patients or eyewitnesses as similar to spontaneous ones. The minimum requirements to perform TTT are a tilt table, a continuous beat-to-beat blood pressure monitor, at least one ECG lead, protocols for the indications stated below and trained staff. This basic equipment lends itself to perform (1) additional provocation tests, such as the active standing test carotid sinus massage and autonomic function tests; (2) additional measurements, such as video, EEG, transcranial Doppler, ☆ Consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN). ☆☆ This article is co-published in the journals "Clinical Autonomic Research" and "Autonomic Neuroscience".

New hemodynamic criteria to separate classical orthostatic hypotension from vasovagal syncope

“…In clinical practice, the presence of emotional triggers for VVS should exclude any confusion with cOH, but in such cases, there usually is no need to perform TTT. 1 , 10 Even so, it is unknown whether spontaneous emotional VVS has the same hemodynamic features as orthostatic VVS we described here. This should not pose any problems, as those with emotional VVS are susceptible to TTT.…”

“…We did not compare TTT results with other tests that can be applied in cOH, such as the Valsalva test or the active stand test. 10 The active stand test usually lasts shorter than a TTT, and so is less likely to evoke VVS, but this is not impossible. We expect that the overall hemodynamic features of VVS and cOH during active stand will be similar to those during TTT.…”

“…The tilt table test (TTT) plays an important role in the work‐up of those with unexplained OI or TLOC. 1 , 7 , 8 , 9 , 10 …”

Types of hemodynamic response to orthostasis according to continuous blood pressure monitoring: a case series of heart failure with reduced ejection fraction

“…АОП отражает краткосрочный ответ сердечно-сосудистой и автономной нервной системы на изменение положения тела [7]. Согласно клиническим рекомендациям по артериальной гипертензии у взрослых [8] измерение артериального давления (АД) при переходе из положения сидя в положение стоя рекомендовано всем пациентам на первом визите для выявления ОГ, а пожилым, пациентам с сахарным диабетом (СД) и другими предрасполагающими факторами -и на каждом последующем визите.…”

“…АОП с непрерывной регистрацией АД (beat-to-beat) представляет наиболее полную характеристику гемодинамического ответа в ортостазе. В согласительном документе Европейской федерации обществ изучения автономной дисфункции, поддержанном Американским обществом изучения автономной дисфункции и Европейской академией неврологии 2021г [7], АОП с непрерывной регистрацией АД, как и тилт-тест, рекомендована при подозрении на рефлекторный обморок (все формы), ОГ (все формы), психогенное псевдосинкопе. Для выявления ранней ОГ методика непрерывной регистрации необходима [9,11].…”