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The Newcastle protocols for head-up tilt table testing in the diagnosis of vasovagal syncope, carotid sinus hypersensitivity, and related disorders
  1. R A Kenny,
  2. D O'Shea,
  3. S W Parry
  1. Cardiovascular Investigation Unit, Victoria Wing, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
  1. Professor Kenny email: R.A.Kenny{at}

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Head-up tilt table testing had been used as an investigative tool in the pathophysiology of orthostatic stress for more than 50 years,1 before the initial demonstration of its utility in the diagnosis of unexplained syncope.2 The Westminster group's landmark study found that 67% of patients with otherwise unexplained syncope demonstrated a vasovagal reaction during head-up tilt, compared to only 10% of healthy controls.2 Head-up tilt table testing has since evolved into the diagnostic test of choice in vasovagal syncope and related disorders, but there are still wide variations in the protocols used in various centres, hampering not only the clinical utility of the test but the adequate assessment of research activity in the field. The following protocols are based on the available evidence and our experience in this field and, as such, provide a practical and standardised approach. They are intended for use by cardiologists and other physicians with an interest in this topic, and hence assume some prior knowledge of the procedure. A more detailed description and justification for the protocols is readily available.3 ,4

Indications for head-up tilt table testing

Head-up tilt table testing should be considered in patients with recurrent syncope or presyncope, or in high risk patients with a history of a single syncopal episode (for example, those suffering serious injury during syncope or those experiencing syncope while driving) where no other cause for symptoms is suggested by initial history, examination or cardiovascular and neurological investigations. Tilt table testing may also be useful in the assessment of elderly patients with recurrent, unexplained falls.5 The head-up tilt table test may also have a role in the differential diagnosis of convulsive syncope,5-7 orthostatic hypotension,8 the postural orthostatic tachycardia syndrome,9 psychogenic10 and hyperventilation11 ,12 syncope, and carotid sinus hypersensitivity.13-15 The Newcastle protocol …

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