[The tilt-table test: is it essential for adequate treatment of vasovagal syncope? Arguments in favor]

Head-Up tilt test (HUT) permits the identification of vasovagal syncope in patients with syncope of unknown origin. Several authors have pointed out its usefulness for the therapeutic management of these patients. However, even though it has limitations, this paper discusses those situations in which HUT may be useful. First, as HUT permits the recognition of the etiologic diagnosis of syncope, it may be helpful in the evaluation of its treatment. On the other hand, the characterization of different components of vasovagal reaction, cardioinhibition and/or vasodepressor response, may be helpful in the selection of therapeutic options. It has been suggested that the performance of HUT may even be beneficial for the relapses of vasovagal syncope in patients with recurrent syncope and refractory to other treatments. Finally, further randomized clinical trials in HUT will help to establish the prediction of therapeutic effectiveness in patients with vasovagal syncope. However, there are important limitations to its usefulness for the clinical management of individual patients.