Why is the Tilt Table Test Still Useful to Define who Should or Should Not Get A Pacemaker with Vasovagal Syncope?

The the tilt table test (TTT )has been used identify appropriate candidates for pacing in the majority of randomized trials. However, in recent years, it has been claimed-based largely on International Study on Syncope of Uncertain Etiology (ISSUE) studies-that the TTT demonstrates only a weak correlation with the mechanism documented by implantable loop recorder (ILR) at the time of syncope and thus confounds the correct diagnosis. Thus, cardiac pacing was supported in patients with recurrent vasovagal syncope (VVS) in whom clinically relevant asystole had been documented by ILR. In the present Editorial, we tried to discuss potential role of TTT in diagnostic workflow of VVS based on current data.