'The Italian Protocol': a simplified head-up tilt testing potentiated withoral nitroglycerin to assess patients with unexplained syncope

Head-up tilt testing potentiated by sublingual nitroglycerin (NTG), advocat ed by an Italian group, is a simple and safe but still not a standardized, diagnostic tool for the investigation of syncope. In fact, owing to its rap id spread, the original protocol received, often arbitrarily, many subseque nt modifications. We now define the best methodology of the test on strictl y evidence-based criteria as: stabilization phase of 5 min in the supine po sition: passive phase of 20 min at a tilt angle of 60 degrees; provocation phase of further 15 min after 400 mug NTG sublingual spray. Test interrupti on is made when the protocol is completed in the absence of symptoms, or th ere is occurrence of syncope, or occurrence of progressive (>5 min) orthost atic hypotension. We intend that this protocol, named by us as 'The Italian Protocol', will be accepted as the standard methodology of the tilt test p otentiated by sublingual nitrates. (Europace 2000; 2: 339-342) (C) 2000 The European Society of Cardiology.