HEAD UP TILT TABLE TEST: IS IT A USEFUL TEST IN CHILDREN

Aim The aim of the study is to evaluate the usefulness of tilt test in syncopal children. Methods A retrospective study of children who had tilt test between January 1997 and December 2001 in two cardiac centres using case notes and telephonic questionnaires. Results 111 children aged 6 to 18 years underwent tilt test, amongst them 81 were referred with history suggestive of vaso-vagal syncope. 63 were boys and 48 were girls. Test was positive in 33 patients (26 with classical history) who developed symptoms during the test (median time of onset 17 minutes) associated with haemodynamic changes (classified as Mixed 18, Cardioinhibition with asystole 6, Cardioinhibition without asystole 3, Vasodepressor 2 and Chronotropic 2). All recovered immediately after tilting back the table and none needed resuscitation. Test was negative in the remaining 78 patients. Advice regarding extra salt was given to 18 in positive group and 12 in negative group. 13 of 15 from positive group and all 4 from negative group who were prescribed medications (betablocker and/or fludrocortisone) discontinued on subsequent follow-up. Pacemakers were implanted in 3 who had asystole for >10 seconds and complete loss of consciousness. Available information revealed that symptoms improved or resolved (by 4 years) in 18 of 23 test positive patients and in 20 of 42 test negative patients. Conclusion Tilt test is safe, useful in selective cases and may guide treatment options. However for majority of patients where there is a clear history it adds very little.