We present an elderly patient who had syncope, with known coronary artery d
isease and a conduction abnormality. Because of a possible vasovagal reacti
on, the patient underwent a tilt table test prior to evaluation of ischemia
or her LV function. During the tilt table test on isoproterenol, the patie
nt developed ventricular fibrillation which was corrected immediately by ca
rdioversion. Subsequently, the patient was found to have significant corona
ry artery disease which was treated with stenting and angioplasty. After tr
eatment, there were no inducible arrhythmias on full dose isoproterenol. Th
is case reports a significant complication that may occur when tilt table t
esting with isoproterenol and ischemia.