[Tilt-table test. Value in children and adolescents]

The tilt test is a non-invasive investigation which reproduces malaises or vagal syncope. This is a common condition in children and adolescents and the value of this investigation in this population is therefore self-evident. The tilt test was performed from 4 years of age in 105 children aged 4 to 18 years (mean 10 +/- 4 years) who had suffered one or several malaises with syncope. This test, using a resting period of 20 minutes, then a tilt of 70-80 degrees for 40 minutes, was considered to be positive if the symptoms could be reproduced or if the heart rate slowed to less than 50/min or if the blood pressure fell by more than 30 mmHg. The test was positive in 46 children (44%). Ten remained asymptomatic but had significant reductions in blood pressure: 36 children reproduced their symptoms. The positivity was related to a cardio-inhibitory response in 4 cases, vasodepressive in 20 cases, mixed in 20 cases and "psychiatric" in 2 cases: sinus tachycardia preceded positivity in 43 of the 46 cases. Only 21 children were treated either by disopyramide (12 cases) or betablockers (9 cases). All but one of the children became asymptomatic but the tilt test remained positive in 7 of the 9 patients treated with betablockers and in 3 children treated with disopyramide. The essential value of this investigation was to stop investigations in positive cases, to reassure parents and the children and to allow the pursuit of sporting activities. The authors conclude that the tilt test is an investigation easy to carry out in the young child and which spares complementary investigation in cases of positivity and guides medical treatment.