HEAD-UP TILT TEST - IS IT ESSENTIAL FOR A N APPROPRIATE TREATMENT OF VASOVAGAL SYNCOPE - ARGUMENTS AGAINST

The knowledge about vasovagal syncope has hugely grown since its initi al description by Lewis in 1932. Nevertheless some critical gaps remai n, affecting specially to the patient management. There are not enough data about the natural history of the process and, because of that, n o useful markers are known to identify patients who need or would bene fit from a specific treatment. A diagnostic test with a sensibility/sp ecificity relationship good enough to be a diagnostic gold standard is lacking. Although tilt-table test can be helpful in diagnosis, its se nsitivity is, nowadays, unknown. Avavilable data about reproducibility of tilt test are scarce and sometimes contradictory, specially with p ositive tilt test results. Should the lack of reproducibility of posit ive results found by some authors be confirmed, the usefulness of seri al tilt tests in selecting treatment would be seriously affected. No e vidence about the existence of an effective treatment for vasovagal sy ncope has been published yet, not either about the advantage of an spe cific strategy in selecting it. Therefore, tilt test has not been prov ed to be a more useful tool in selecting therapy for patients with vas ovagal syncope.