Tilt-Table Testing Periprocedural Care
- Author: James V Talano, MD, MBA; Chief Editor: Karlheinz Peter, MD, PhD more...
Patient Education & Consent
Discuss the test findings with both the patient and a companion to increase proper understanding of the results.
To avoid dehydration on the day of the study in patients who have been NPO after midnight, or receiving diuretic therapy, infuse 250 mL of 0.9% saline prior to tilt testing. Administer IV saline cautiously in patients with heart failure or renal failure.
Hold all medications the night before the procedure and in the morning to increase the sensitivity of the study. However, if diuretic or antihypertensive medications are a suspected etiology of syncopal episodes, allow the patient to take medications as usual the morning of the procedure.
Equipment/personnel should be as follows:
Blood pressure monitor
Heart rate monitor
ECG rhythm monitor
Oxygen saturation monitor
Crash cart with defibrillator available
Quiet, air conditioned room
Soft background music (optional)
Direct physician supervision and nurse or trained technician assistance
Anesthesia is not to be used for this procedure. The patient must remain alert and awake to detect the moment of unconsciousness.
See the Technique section.
Monitoring & Follow-up
Discharge patient to home if blood pressure and heart rate are back to baseline and patient is not symptomatic.
Advise patient not to drive for 2 hours after the procedure.
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|Tilt table is indicated in the case of an unexplained single syncopal episode in high-risk settings (eg, occurrence of, or potential risk of physical injury or with occupational implications)or recurrent episodes in the absence of organic heart disease, after cardiac causes of syncope have been excluded||I||B|
|Tilt testing is indicated when it is of clinical value to demonstrate susceptibility to reflex syncope to the patient||I||C|
|Tilt testing should be considered to discriminate between reflex and orthostatic hypotensive syncope||IIa||C|
|Tilt testing may be considered for differentiating syncope with jerking movement from epilepsy||IIb||C|
|Tilt testing may be indicated for evaluating patients with recurrent unexplained falls||IIb||C|
|Tilt testing may be indicated for evaluating patients with frequent syncope and psychiatric disease||IIb||C|
|Tilt testing is not recommended for assessment of treatment||III||B|
|Isoproterenol tilt testing is contraindicated in patients with ischemic heart disease||III||C|
|Type 1 -
|Heart rate falls at the time of syncope, but the ventricular rate does not fall to less than 40 beats/min-1 or falls to less 40 beats/min-1 for less than 10 s with or without asystole of less than 3 s. Blood pressure falls before the heart rate falls.|
|Type 2 -
|A) Cardioinhibition without asystole: heart rate falls to a ventricular rate less than 40 beats/min-1 for more than 10 s, but asystole of more than 3 s does not occur before the heart rate falls.
B) Cardioinhibition with asystole: Asystole occurs for more than 3 s. Blood pressure falls with or occur before the heart rate fall.
|Type 3 -
|Heart rate does not fall more than 10% from its peak at the time of syncope.|
|Exception 1. Chronotropic incompetence: No heart rate rise during the tilt testing (ie, less than 10% from the pre-tilt rate).|
|Exception 2. Excessive heart rate rise: An excessive heart rate both at the onset of the position and throughout its duration before syncope (ie, greater than 130 beats/min-1).|