{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T05:46:27Z","timestamp":1791438387886,"version":"4.3.3"},"reference-count":55,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,10,15]],"date-time":"2023-10-15T00:00:00Z","timestamp":1697328000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Physio Funct Imaging"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Tilt table testing (TTT) has been used for decades to study short\u2010term blood pressure (BP) and heart rate regulation during orthostatic challenges. TTT provokes vasovagal reflex in many syncope patients as a background of widespread use. Despite the availability of evidence\u2010based practice syncope guidelines, proper application and interpretation of TTT in the day\u2010to\u2010day care of syncope patients remain challenging. In this review, we offer practical information on what is needed to perform TTT, how results should be interpreted including the Vasovagal Syncope International Study classification, why syncope induction on TTT is necessary in patients with unexplained syncope and on indications for TTT in syncope patient care. The minimum requirements to perform TTT are a tilt table with an appropriate tilt\u2010down time, a continuous beat\u2010to\u2010beat BP monitor with at least three electrocardiogram leads and trained staff. We emphasize that TTT remains a valuable asset that adds to history building but cannot replace it, and highlight the importance of recognition when TTT is abnormal even without syncope. Acknowledgement by the patient\/eyewitness of the reproducibility of the induced attack is mandatory in concluding a diagnosis. TTT may be indicated when the initial syncope evaluation does not yield a certain, highly likely, or possible diagnosis, but raises clinical suspicion of (1) reflex syncope, (2) orthostatic hypotension (OH), (3) postural orthostatic tachycardia syndrome or (4) psychogenic pseudosyncope. A therapeutic indication for TTT in the patient with a certain, highly likely or possible diagnosis of reflex syncope, may be to educate patients on prodromes. In patients with reflex syncope with OH TTT can be therapeutic to recognize hypotensive symptoms causing near\u2010syncope to perform physical countermanoeuvres for syncope prevention (biofeedback). Detection of hypotensive susceptibility requiring therapy is of special value.<\/jats:p>","DOI":"10.1111\/cpf.12859","type":"journal-article","created":{"date-parts":[[2023,10,15]],"date-time":"2023-10-15T13:19:06Z","timestamp":1697375946000},"page":"119-130","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Tilt table testing, methodology and practical insights for the clinic"],"prefix":"10.1111","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1784-9558","authenticated-orcid":false,"given":"Steven","family":"van Zanten","sequence":"first","affiliation":[{"name":"Department of Cardiology Reinier de Graaf Gasthuis Delft The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Sutton","sequence":"additional","affiliation":[{"name":"Department of Cardiology National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Campus London UK"},{"name":"Department of Clinical Sciences Lund University Malm\u00f6 Sweden"},{"name":"Department of Cardiology Sk\u00e5ne University Hospital Malm\u00f6 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktor","family":"Hamrefors","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund University Malm\u00f6 Sweden"},{"name":"Department of Cardiology Sk\u00e5ne University Hospital Malm\u00f6 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artur","family":"Fedorowski","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund University Malm\u00f6 Sweden"},{"name":"Department of Cardiology Sk\u00e5ne University Hospital Malm\u00f6 Sweden"},{"name":"Department of Cardiology Karolinska University Hospital and Karolinska Institute Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik J.","family":"de Lange","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Cardiology, Heart Centre Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,15]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad182"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(86)91665-x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eux298"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/eupc.2000.0125"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002184"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1053\/eupc.1999.0064"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy037"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy071"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000002800"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2007.00984.x"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.120.316662"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2022.05.009"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2009.99"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10286-017-0409-7"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.121.010573"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10286-017-0424-8"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(89)92155-7"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10286-011-0119-5"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.51412"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-016-8375-x"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eup338"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.12590"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2017.12.013"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2018-313741"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euaa345"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.5.515"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e318293e1c7"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12356"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euac193"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00260.2002"},{"issue":"4","key":"e_1_2_9_32_1","first-page":"19","article-title":"Postural tachycardia syndrome (POTS)","volume":"45","author":"Low P.A.","year":"1995","journal-title":"Neurology"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-med-041818-011630"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euv283"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1161\/hc3601.095708"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1136\/heart.84.5.509"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.211373"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.06.1084"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2018.04.033"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euac154"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10286-022-00864-3"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad322"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2015.07.037"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2017.07.006"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.10.090"},{"issue":"1","key":"e_1_2_9_46_1","first-page":"38","article-title":"Tilt testing for syncope: a reappraisal","volume":"20","author":"Sheldon R.","year":"2005","journal-title":"Current Opinion in Cardiology"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu255"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab084"},{"key":"e_1_2_9_49_1","first-page":"180","article-title":"Proposed classification for tilt induced vasovagal syncope","volume":"2","author":"Sutton R.","year":"1992","journal-title":"European Journal of Cardiac Pacing and Electrophysiology"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10286-020-00738-6"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2020.00021"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(22)00169-7"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10286-016-0382-6"},{"key":"e_1_2_9_54_1","doi-asserted-by":"crossref","unstructured":"vanZanten S. deJong J.S.Y. Scheffer M.G. Kaal E.C.A. deGroot J.R.&deLange F.J.(2023)A cross\u2010sectional nationwide survey of guideline based syncope units in the Netherlands. The SU\u201019 score: a novel validation for best practices.","DOI":"10.1093\/europace\/euae002"},{"key":"e_1_2_9_55_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euv262"},{"key":"e_1_2_9_56_1","unstructured":"Zysko D. Jamil R.T. Anilkumar A.C. (2023)Tilt Table. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing [Updated 2023 Jun 20]. Available from:https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482320\/"}],"container-title":["Clinical Physiology and Functional Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cpf.12859","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T04:39:45Z","timestamp":1707367185000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cpf.12859"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,15]]},"references-count":55,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1111\/cpf.12859"],"URL":"https:\/\/doi.org\/10.1111\/cpf.12859","archive":["Portico"],"relation":{},"ISSN":["1475-0961","1475-097X"],"issn-type":[{"value":"1475-0961","type":"print"},{"value":"1475-097X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,15]]},"assertion":[{"value":"2023-04-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}