VALUE OF THE TILT TEST IN CHILDREN AND AD OLESCENTS

The tilt test is a non-invasive investigation which reproduces malaise s or vagal syncope. This is a common condition in children and adolesc ents and the value of this investigation in this population is therefo re self-evident. The tilt test was performed from 4 years of age in 10 5 children aged 4 to 18 years (mean 10 +/- 4 years) who had suffered o ne or several malaises with syncope. This test, using a resting period of 20 minutes, then a tilt of 70-80 degrees for 40 minutes, was consi dered to be positive if the symptoms could be reproduced or if the hea rt rate slowed to less than 50/min or if the blood pressure fell by mo re than 30 mmHg. The test was positive in 46 children (44 %). Ten rema ined asymptomatic but had significant reductions in blood pressure ; 3 6 children reproduced their symptoms. The positivity was related to a car die-inhibitory response in 4 cases, vasodepressive in 20 cases, mi xed in 20 cases and ''psychiatric'' in 2 cases; sinus tachycardia prec eded positivity in 43 of the 46 cases. Only 21 children were treated e ither by disopyramide (12 cases) or betablockers (9 cases). All but on e of the children became asymptomatic but the tilt test remained posit ive in 7 of the 9 patients treated with betablockers and in 3 children treated with disopyramide. The essential value of this investigation was to stop investigations in positive cases, to reassure parents and the children and to allow the pursuit of sporting activities. The auth ors conclude that the tilt test is an investigation easy to carry out in the young child and which spares complementary investigation in cas es of positivity and guides medical treatment.