Recurrent unexplained syncope in the elderly: the use of head-upright tilt table testing in evaluation and management

J Am Geriatr Soc. 1992 Nov;40(11):1123-8. doi: 10.1111/j.1532-5415.1992.tb01801.x.


Objective: To investigate the usefulness of head-upright tilt table testing for vasovagal episodes in the evaluation and management of elderly patients with recurrent idiopathic syncope.

Design: Prospective survey.

Setting: Electrophysiology laboratory of a university hospital.

Patients: Twenty-five patients (11 male, 14 female; mean age 73 +/- 6 years) with recurrent unexplained syncope and seven control subjects with other causes of syncope (4 male, 3 female; mean age 70 +/- 4 years).

Methods: Each patient underwent head-upright tilt table testing for 30 minutes with or without an infusion of isoproterenol (1-3 micrograms/min given intravenously) in an attempt to provoke bradycardia, hypotension, or both.

Main results: Syncope occurred in nine patients (36%) during the baseline tilt and in seven patients (28%) during isoproterenol infusion (total positives 64%). None of the controls had syncope during the test. All of the patients who had positive test results eventually became tilt table negative with therapy, and over a mean follow-up period of 24 months, no further syncopal episodes have occurred.

Conclusions: Head-upright tilt table testing combined with isoproterenol infusion may be a useful tool in the diagnosis of vasovagal syncope in the elderly and in the evaluation of preventive therapy.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atenolol / administration & dosage
  • Atenolol / therapeutic use
  • Beds / standards*
  • Blood Pressure
  • Disopyramide / administration & dosage
  • Disopyramide / therapeutic use
  • Drug Therapy, Combination
  • Electrocardiography
  • Electrophysiology
  • Female
  • Head*
  • Humans
  • Isoproterenol* / administration & dosage
  • Male
  • Monitoring, Physiologic
  • Posture*
  • Prospective Studies
  • Recurrence
  • Scopolamine / administration & dosage
  • Scopolamine / therapeutic use
  • Syncope / diagnosis*
  • Syncope / drug therapy
  • Syncope / epidemiology


  • Atenolol
  • Scopolamine
  • Disopyramide
  • Isoproterenol