An Audit of the Head Up Tilt Table Test at a Tertiary Care University Hospital

Syncope is a self-limiting transient loss of consciousness (TLOC) caused by cerebral hypo-perfusion, which can be classified into orthostatic, cardiac, or vasovagal etiologies on the basis of tilt table test. We conducted a single-center retrospective chart review study of patients above 16 years of age who underwent HUTT testing from January 2010 to March 2020. Charts were reviewed for basic demographic data and indication and outcome of test. Correlation of age, gender, and presenting symptoms with results of HUTT test were analyzed. Our study included 496 patients with 72.2% males and mean age of 51.1 years. Vasovagal syncope was found to be the most common etiology (79.8%, n=158), followed by orthostatic syncope (11.6%, n=23), autonomic syncope (6.1%, n=12) and postural orthostatic tachycardia syndrome (2.5%, n=5). Vasovagal syncope was further divided into three subtypes, with most common being mixed type (82.3%,n=130), followed by pure vasodepressor (14.6%, n=23) and cardio-inhibitory(3.2%,n=5). The two most common prodromal symptoms were loss of consciousness (45.8%, n=227) with or without preceding dizziness followed by dizziness alone (34.5%, n=171). Both of these symptoms had a statistical significance when compared to the diagnostic yield of HUTT testing (p value <0.05). No significant correlation (p value >0.05) was found between the presenting symptoms, age, gender and outcomes on HUTT testing. We concluded that the most common etiology of syncope is vasovagal, predominantly the mixed type. LOC and dizziness were found to be statistically significant in relation with the yield HUTT testing.