Purpose Tilt table testing (TTT) may have a role in the management of vasovagal syncope (VVS), as it may provoke symptoms in patients with suggestive symptoms. We sought to investigate the role of TTT in the management of VVS.

Methods We conducted a retrospective case-control study of children with VVS symptoms over a 20 year period. We assessed presenting symptoms, disease burden and the appropriateness of TTT. Disease burden was assessed using a scoring system based on frequency of symptoms and psychosocial impact. Patients were identified from an electronic database. Data were analysed using SPSS with chi-square tests and independent t-tests. We rejected the null hypothesis if p- values were less than 0.05.

Results 50 cases with VVS features who had undergone TTT between 1997 and 2016 were compared to 50 historical controls with VVS but no TTT. The cases were age (p=0.56) and sex (p=0.84) matched. All TTT conducted had an appropriate indication. TTT cases had a significantly higher burden of disease (p=0.03), and were more likely to have pharmacological (p=0.001), and psychological intervention (p=0.02) than controls.

Conclusion TTT is a useful tool in the diagnosis of complex cases of VVS. Patients undergoing TTT were more likely to have troublesome symptoms and a higher likelihood of drug and psychological intervention. TTT helped to confirm the diagnosis of VVS and may have enabled treatments to be more targeted and specific.