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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)

Thijs, R. and Brignole, M. and Falup-Pecurariu, C. and Fanciulli, A. and Freeman, R. and Guaraldi, P. and Jordan, J. and Habek, M. and Hilz, M.J. and Traon, A. and Stankovic, I. and Struhal, W. and Sutton, R. and Wenning, G.K. and Van Dijk, J. G. (2021) 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). Clinical Autonomic Research, 31 (3), pp. 369-384. Springer. doi: 10.1007/s10286-020-00738-6. ISSN 0959-9851.

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Official URL: http://dx.doi.org/10.1007/s10286-020-00738-6

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 events. 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 the performance of (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, NIRS, end-tidal CO2 or neuro-endocrine tests; and (3) tailor-made provocation procedures in those with a specific and consistent trigger of TLOC. TTT and other provocative cardiovascular autonomic tests are indicated if the initial evaluation does not yield a definite or highly likely diagnosis, but raises a suspicion of (1) reflex syncope, (2) the three forms of orthostatic hypotension (OH), i.e. initial, classic and delayed OH, as well as delayed orthostatic blood pressure recovery, (3) postural orthostatic tachycardia syndrome or (4) psychogenic pseudosyncope. A therapeutic indication for TTT is to teach patients with reflex syncope and OH to recognise hypotensive symptoms and to perform physical counter manoeuvres.

Item URL in elib:https://elib.dlr.de/144586/
Document Type:Article
Title: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)
Authors:
AuthorsInstitution or Email of AuthorsAuthor's ORCID iDORCID Put Code
Thijs, R.Stichting Epilepsie Instellingen Nederland, Heemstede and Department of Neurology, Leiden University Medical CentreUNSPECIFIEDUNSPECIFIED
Brignole, M.Faint and Fall Programme, Department of Cardiology, Ospedale San Luca, IRCCS Istituto Auxologico Italiano, Milan, ItalyUNSPECIFIEDUNSPECIFIED
Falup-Pecurariu, C.Department of Neurology, County Emergency Clinic Hospital, Transilvania University, Brasov, RomaniaUNSPECIFIEDUNSPECIFIED
Fanciulli, A.Department of Neurology, Innsbruck Medical UniversityUNSPECIFIEDUNSPECIFIED
Freeman, R.Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USAUNSPECIFIEDUNSPECIFIED
Guaraldi, P.IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, ItalyUNSPECIFIEDUNSPECIFIED
Jordan, J.UNSPECIFIEDhttps://orcid.org/0000-0003-4518-0706UNSPECIFIED
Habek, M.Referral Center for Autonomic Nervous System, Department of Neurology, School of Medicine, University Hospital Center Zagreb, University of Zagreb, Kispaticeva 12, 10000, Zagreb, CroatiaUNSPECIFIEDUNSPECIFIED
Hilz, M.J.Department of Neurology, Universitätsklinikum Erlangen and Department of Neurology, Icahn School of MedicineUNSPECIFIEDUNSPECIFIED
Traon, A.Neurology Department, French Reference Center for MSA, University Hospital of Toulouse and INSERM U 1048, Toulouse, FranceUNSPECIFIEDUNSPECIFIED
Stankovic, I.Clinical Center of Serbia, Neurology Clinic, University of Belgrade, Belgrade, SerbiaUNSPECIFIEDUNSPECIFIED
Struhal, W.Department of Neurology, Karl Landsteiner University of Health Sciences, Site Tulln, Tulln, AustriaUNSPECIFIEDUNSPECIFIED
Sutton, R.Department of Cardiology, National Heart and Lung Institute, Hammersmith Hospital, Ducane Road, London, W12 0NN, UKUNSPECIFIEDUNSPECIFIED
Wenning, G.K.Department of Neurology, Innsbruck Medical University,UNSPECIFIEDUNSPECIFIED
Van Dijk, J. G.Department of Neurology, Leiden University Medical Centre, Leiden, The NetherlandsUNSPECIFIEDUNSPECIFIED
Date:June 2021
Journal or Publication Title:Clinical Autonomic Research
Refereed publication:Yes
Open Access:Yes
Gold Open Access:No
In SCOPUS:Yes
In ISI Web of Science:Yes
Volume:31
DOI:10.1007/s10286-020-00738-6
Page Range:pp. 369-384
Publisher:Springer
ISSN:0959-9851
Status:Published
Keywords:Orthostatic hypotension; Psychogenic pseudosyncope; Reflex syncope; Syncope; Tilt table testing; Transient loss of consciousness; Vasovagal
HGF - Research field:Aeronautics, Space and Transport
HGF - Program:Space
HGF - Program Themes:Research under Space Conditions
DLR - Research area:Raumfahrt
DLR - Program:R FR - Research under Space Conditions
DLR - Research theme (Project):R - CardioBrain
Location: Köln-Porz
Institutes and Institutions:Institute of Aerospace Medicine
Institute of Aerospace Medicine > Cardiovascular Medicine in Aerospace
Institute of Aerospace Medicine > Leitungsbereich ME
Deposited By: Schrage, Larissa
Deposited On:21 Oct 2021 12:23
Last Modified:21 Jun 2023 15:29

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