Twenty-eight years of research permit reinterpretation of tilt-testing: hypotensive susceptibility rather than diagnosis.

There is growing scepticism over utility of tilt-testing for syncope diagnosis, which has been shown unable to distinguish vasovagal from other syncope, especially cardiac, despite its acceptable sensitivity and specificity in true positive and negative subjects. The new interpretation is that the test reveals a susceptibility to reflex hypotension, which may exist in coincidence with any cause of syncope. This implies an important change in patient management including selecting effective therapy, in particular in guiding pacemaker therapy in patients affected by reflex syncope.