Twenty-eight years of research permit reinterpretation of tilt-testing: hypotensive susceptibility rather than diagnosis

Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)

Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), societies, E. B. T. F., European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp298 · Cited by 2,040 · see citing works

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PASSIVE IMMUNITY AGAINST CHILDHOOD CANCER

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Benefit of Pacemaker Therapy in Patients With Presumed Neurally Mediated Syncope and Documented Asystole Is Greater When Tilt Test Is Negative: An Analysis From the Third International Study on Syncope of Uncertain Etiology (ISSUE-3)

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The normal response to prolonged passive head up tilt testing

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An abnormal neural reflex plays a role in causing syncope in sinus bradycardia

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Withdrawal of fall-risk-increasing drugs in older persons: effect on tilt-table test outcomes

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Diagnosis of neurally mediated syncope at initial evaluation and with tilt table testing compared with that revealed by prolonged ECG monitoring. An analysis from the Third International Study on Syncope of Uncertain Etiology (ISSUE-3)

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A positive response to head-up tilt testing predicts syncopal recurrence in carotid sinus syndrome patients with permanent pacemakers

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Reduced Cardiopulmonary Baroreflex Sensitivity in Patients With Hypertrophic Cardiomyopathy 11Drs. Frenneaux, Morris-Thurgood and Atherton were supported by the British Heart Foundation, London. This study was supported in part by Project Grant 665 941193 and Scholarship Grant 948220 from the NH&MRC of Australia.

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Recurrent vasovagal syncope: comparison between clomipramine and nitroglycerin as drug challenges during head-up tilt testing

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Effects of chronic vasodilator therapy to enhance susceptibility to vasovagal syncope during upright tilt testing

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Effect of clinical triggers on positive responses to tilt-table testing potentiated with nitroglycerin or clomipramine

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Nitrate-potentiated head-up tilt testing (HUT) has a low diagnostic yield in patients with likely vasovagal syncope

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Aortic stenosis and autonomic dysfunction: co-conspirators in syncope

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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy

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2018 ESC Guidelines for the diagnosis and management of syncope

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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy

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Cardiac pacing in severe recurrent reflex syncope and tilt-induced asystole

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Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness

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The management of vasovagal syncope

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Tilt testing remains a valuable asset

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Assessment of a standardized algorithm for cardiac pacing in older patients affected by severe unpredictable reflex syncopes

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Standardized algorithm for cardiac pacing in older patients affected by severe unpredictable reflex syncope: 3-year insights from the Syncope Unit Project 2 (SUP 2) study

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Novel Methods for Quantification of Vasodepression and Cardioinhibition During Tilt-Induced Vasovagal Syncope

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The pathophysiology of vasovagal syncope: Novel insights

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Association between hypotension during 24 h ambulatory blood pressure monitoring and reflex syncope: the SynABPM 1 study

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Usefulness of post-procedural heart rate response to predict syncope recurrence or positive head up tilt table testing after cardioneuroablation

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Carotid sinus syndrome: Progress in understanding and management

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Temporal Relationship of Asystole to Onset of Transient Loss of Consciousness in Tilt-Induced Reflex Syncope

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Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness : Consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN)

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Low-blood pressure phenotype underpins the tendency to reflex syncope

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Twenty-five years of research on syncope

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Syncope: Diagnosis and Management

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New insights in diagnostics and therapies in syncope: a novel approach to non-cardiac syncope

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The benefit of pacemaker therapy in patients with neurally mediated syncope and documented asystole: a meta-analysis of implantable loop recorder studies

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Adenosine and clinical forms of neurally-mediated syncope

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Timing of Circulatory and Neurological Events in Syncope

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Clinical history in management of suspected syncope: A powerful diagnostic tool

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Cardiac and Vascular Sympathetic Baroreflex Control during Orthostatic Pre-Syncope

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Reflex syncope: Diagnosis and treatment

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Tilt table testing in neurology and clinical neurophysiology

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Pacing in vasovagal syncope: Physiology, pacemaker sensors, and recent clinical trials—Precise patient selection and measurable benefit

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Cerebral Oximetry in Syncope and Syndromes of Orthostatic Intolerance

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Improved health-related quality of life after cardioneuroablation in patients with vasovagal syncope

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Guía ESC 2021 sobre estimulación cardiaca y terapia de resincronización

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Tests for the identification of reflex syncope mechanism

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Twenty‐Four‐Hour Ambulatory Blood Pressure Profile in Patients With Reflex Syncope and Matched Controls

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Syndromes of orthostatic intolerance and syncope in young adults

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Pathophysiology of syncope: current concepts and their development

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Manual zur Diagnostik und Therapie von Synkopen

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Tilt testing results are influenced by tilt protocol

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Kommentar zu den Leitlinien (2018) der European Society of Cardiology (ESC) zur Diagnostik und Therapie von Synkopen

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Should we treat severe vasovagal syncope with a pacemaker?

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Cardiovascular Autonomic Dysfunction Is the Most Common Cause of Syncope in Paced Patients

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Tilt table testing, methodology and practical insights for the clinic

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Syncope in Patients with Pacemakers

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Blood pressure management in hypertensive patients with syncope: how to balance hypotensive and cardiovascular risk

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Pacing therapy in the management of unexplained syncope: a tertiary care centre prospective study

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Development and evaluation of a novel system for inducing orthostatic challenge by tilt tests and lower body negative pressure

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Syncope: new solutions for an old problem

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Vasovagal syncope with asystole: the role of cardiac pacing

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A new guideline for diagnosis and treatment of syncope in children and adolescents that stimulates further thought and discussion

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Underlying hemodynamic differences are associated with responses to tilt testing

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Mechanisms of tilt‐induced vasovagal syncope in healthy volunteers and postural tachycardia syndrome patients without past history of syncope

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Does A Therapy for Reflex Vasovagal Syncope Really Exist?

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Complementary effectiveness of carotid sinus massage and tilt testing for the diagnosis of reflex syncope in patients older than 40 years: a cohort study

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Syncope and bundle branch block

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Unexplained falls in the elderly

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Tilt testing evolves: faster and still accurate

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Pacing in vasovagal syncope: A physiological paradox?

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Assessment of endothelin and copeptin as biomarkers for vasovagal syncope

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Incidence and predictors of syncope recurrence after cardiac pacing in patients with carotid sinus syndrome

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Vasovagal Syncope: A Review of Current and Future Strategies

Dani, M., Panagopoulos, D., Dirksen, A., Taraborrelli, P., Torocastro, M., Sutton, R., & Lim, P. B. (2021) · European Journal of Arrhythmia & Electrophysiology · doi:10.17925/ejae.2021.7.1.40 · Cited by 8 · see citing works

Characteristics of deceleration capacity and deceleration runs in vasovagal syncope

Li, J., Sun, W., Yang, X., Tu, B., Cai, S., Hu, F., Weng, Z., Liu, S., Lai, Z., Zheng, L., et al. (2023) · Clinical Autonomic Research · doi:10.1007/s10286-023-00989-z · Cited by 8 · see citing works

The pathophysiologic mechanisms associated with hypotensive susceptibility

Chaddha, A., Rafanelli, M., Brignole, M., Sutton, R., WENZKE, K. E., Wasmund, S. L., Page, R. L., & Hamdan, M. H. (2016) · Clinical Autonomic Research · doi:10.1007/s10286-016-0362-x · Cited by 8 · see citing works

Tilt testing

Cooper, P. N., & Sutton, R. (2023) · Practical Neurology · doi:10.1136/pn-2023-003749 · Cited by 7 · see citing works

Usefulness of Tilt Testing and Carotid Sinus Massage for Evaluating Reflex Syncope

Rivasi, G., Rafanelli, M., & Ungar, A. (2018) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2018.04.033 · Cited by 7 · see citing works

Emerging concepts in diagnosis and treatment of syncope by pacing

Sutton, R., Deharo, J., Brignole, M., & Hamdan, M. H. (2018) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2018.01.009 · Cited by 6 · see citing works

Syncope in Patients with Cardiac Pacemakers

Rocha, E. A., Cunha, G. S., Tavares, A. B., Júnior, A. B. V., Quidute, A. R. P., Pereira, F. T. M., Monteiro, M. D. P. M., Rocha, M. E. Q. A., Gomes, C. R. F., & Sobrinho, C. R. M. R. (2020) · Brazilian Journal of Cardiovascular Surgery · doi:10.21470/1678-9741-2020-0076 · Cited by 4 · see citing works

Haemodynamic effects of fludrocortisone and midodrine in patients with symptoms due to hypotension

de Lange, F. J., van Zanten, S., Rivasi, G., Groppelli, A., Russo, V., Maggi, R., Capacci, M., Nawaz, S., Comune, A., Ungar, A., et al. (2024) · Clinical Autonomic Research · doi:10.1007/s10286-024-01096-3 · Cited by 5 · see citing works

Cardiovascular and Cerebral Hemodynamics in Asymptomatic Healthy Subjects With/Without Abnormal Head-up Tilt Test Versus Recurrent Fainters

González-Hermosillo, A., Sierra-Beltrán, M., López-Peña, U., Kostin, A., Hernández‐Pacheco, G., & Lerma, C. (2017) · Journal of Clinical Neurophysiology · doi:10.1097/wnp.0000000000000430 · Cited by 5 · see citing works

The future of cardioneuroablation in cardiovascular medicine

Aksu, T., Khan, A., & Huang, H. D. (2022) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2022.2147926 · Cited by 5 · see citing works

A long-term follow-up of patients with prolonged asystole of greater than 15s on head-up tilt testing

Sau, A., Mereu, R., Taraborrelli, P., Dhutia, N. M., Willson, K., Hayat, S. A., Francis, D. P., Sutton, R., & Lim, P. B. (2015) · International Journal of Cardiology · doi:10.1016/j.ijcard.2015.10.090 · Cited by 5 · see citing works

Evaluación clínica de las Disautonomías

Juan Idiáquez, C., Juan Francisco Idiáquez, R., & Benarroch, E. E. (2020) · Revista chilena de neuro-psiquiatría · doi:10.4067/s0717-92272020000400324 · Cited by 5 · see citing works

Evaluation of Patients with Syncope in the Emergency Department: How to Adjust Pharmacological Therapy

Rafanelli, M., Testa, G. D., Rivasi, G., & Ungar, A. (2021) · Medicina · doi:10.3390/medicina57060603 · Cited by 4 · see citing works

Functional Syncope in Children and Adolescents: A Retrospective Cohort Study

Jarjour, I. T., Jarjour, L. K., Tran, K., & Czyzewski, D. I. (2024) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2024.10.010 · Cited by 6 · see citing works

How does the estimated phase of menstrual cycle or menopause influence the prevalence of vasovagal syncope induced by head-up tilt test

Pietrucha, A. Z., Jędrzejczyk-Spaho, J., Konduracka, E., Bzukala, I. B., Krawczyk, K., Kruszelnicka-Kwiatkowska, O., & Nessler, J. M. (2016) · Cardiology Journal · doi:10.5603/cj.a2016.0067 · Cited by 4 · see citing works

A contemporary review of the head-up tilt test: Utility and limitations

Udyavar, A. R., Shenthar, J., Naik, A. M., Khanra, D., Ramalingam, V., Singhal, R., Choudhary, D., Gupta, P. N., Rao, B. H., Mehrotra, S., et al. (2025) · Indian Heart Journal · doi:10.1016/j.ihj.2025.03.014 · Cited by 9 · see citing works

The Current Indication for Pacemaker in Patients with Cardioinhibitory Vasovagal Syncope

da Silva, R. M. F. L. (2016) · The Open Cardiovascular Medicine Journal · doi:10.2174/1874192401610010179 · Cited by 3 · see citing works

Pacing for neurally-mediated syncope: How to decide?

Brignole, M. (2014) · Cardiology Journal · doi:10.5603/cj.2014.0092 · Cited by 3 · see citing works

Isoprenaline versus nitroglycerine in head-up tilt test

Bilagi, U. R., Shenthar, J., & Cholenahally, M. N. (2016) · Indian Heart Journal · doi:10.1016/j.ihj.2016.06.007 · Cited by 3 · see citing works

Head-Up Tilt Test in Risk Stratification of Patients with Hypertrophic Cardiomyopathy

Šedivá, H., Hnát, T., Bonaventura, J., Slesarenko, J., & Veselka, J. (2019) · International Journal of Angiology · doi:10.1055/s-0039-1688983 · Cited by 3 · see citing works

Autonomes Nervensystem und Reflexsynkope

BOSCH, R. F. (2021) · Herzschrittmachertherapie + Elektrophysiologie · doi:10.1007/s00399-021-00775-2 · Cited by 3 · see citing works

Psychogenic symptoms are not only for the epileptologist

Benbadis, S. R., & Sutton, R. (2015) · Neurology · doi:10.1212/wnl.0000000000002183 · Cited by 3 · see citing works

Diagnostic yield of nitroglycerin-potentiated head-up tilt test in a pediatric population with suspected reflex syncope

Russo, V., Comune, A., Nardo, G. D., Parente, E., Marco, G. M. D., Nigris, A. D., Russo, M. G., Sarubbi, B., Nigro, G., & Brignole, M. (2025) · Clinical Autonomic Research · doi:10.1007/s10286-025-01145-5 · Cited by 2 · see citing works

Novel Therapeutic Options in the Management of Reflex Syncope

Podoleanu, C., & Deharo, J. (2019) · American Journal of Therapeutics · doi:10.1097/mjt.0000000000000923 · Cited by 2 · see citing works

2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Translation of the document prepared by the Czech Society of Cardiology

Táborský, M., Kautzner, J., Fedorco, M., Čurila, K., Wünschová, H., Pyszko, J., Novák, M., Kozák, M., Válek, M., Polášek, R., et al. (2022) · Cor et Vasa · doi:10.33678/cor.2022.024 · Cited by 2 · see citing works

Prospective randomized study comparing permanent pacing with rate drop response and closed loop stimulation in patients with vasovagal syncope where permanent pacing is indicated and selected as the appropriate treatment option

Prakash, A., & Sutton, R. (2023) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.15991 · Cited by 2 · see citing works

Dizziness, Syncope, and Autonomic Dysfunction in Children

Kakavand, B. (2022) · Progress in Pediatric Cardiology · doi:10.1016/j.ppedcard.2022.101512 · Cited by 2 · see citing works

Clinical Presentation and Diagnosis of Vasovagal Syncope

Alboni, P., Dipaola, F., Coppola, P., & Furlan, R. (2014) · Springer eBooks · doi:10.1007/978-3-319-09102-0_11 · Cited by 2 · see citing works

Evaluation and Management of Reflex Vasovagal Syncope—A Review

Udyavar, A. R., & Deshpande, S. A. (2021) · Indian Journal of Clinical Cardiology · doi:10.1177/26324636211050154 · Cited by 2 · see citing works

Orthostatic Intolerance

Idiaquez, J. F., Benarroch, E. E., & Nogués, M. A. (2018) · Springer eBooks · doi:10.1007/978-3-319-72251-1_12 · Cited by 2 · see citing works

Tilt test in paced patients: Is it worth the effort?

Bhargava, K. (2015) · Indian Pacing and Electrophysiology Journal · doi:10.1016/j.ipej.2015.10.009 · Cited by 2 · see citing works

Reply to ‘Letter to the Editor’ regarding the article ‘Should we treat severe vasovagal syncope with a pacemaker?’

Sutton, R. (2017) · Journal of Internal Medicine · doi:10.1111/joim.12642 · Cited by 2 · see citing works

Improving the approach to non-cardiac syncope in the emergency department observation unit

Numeroso, F., & Casagranda, I. (2022) · World Journal of Emergency Medicine · doi:10.5847/wjem.j.1920-8642.2023.017 · Cited by 1 · see citing works

Primary cerebral autoregulation dysfunction: a distinct subtype of vasovagal syncope

Hou, M., Wu, J., Ren, L., & Liming, C. (2026) · Acta Neurologica Belgica · doi:10.1007/s13760-026-03026-8 · Cited by 1 · see citing works

Syncope and Unexplained Falls in the Elderly

Rafanelli, M., Brignole, M., & Kenny, R. A. (2017) · Springer eBooks · doi:10.1007/978-3-319-43468-1_7 · Cited by 1 · see citing works

Pacing in neurocardiogenic/vasovagal syncope

Sutton, R. (2018) · Herzschrittmachertherapie + Elektrophysiologie · doi:10.1007/s00399-018-0564-0 · Cited by 1 · see citing works

2018 KHRS guideline for the evaluation and management of syncope-Part 1

Park, J., Cha, M.-J., Kim, D. H., Kim, Y. R., Mun, H. S., Bae, E. J., Seo, D. W., Song, M. K., Ahn, J., Yoon, H. D., et al. (2018) · International Journal of Arrhythmia · doi:10.18501/arrhythmia.2018.009 · Cited by 1 · see citing works

2018 KHRS guideline for the evaluation and management of syncope-Part 2

Kim, Y. R., Chun, K. J., Kim, J. S., Mun, H. S., Park, J., Seo, D. W., Song, M. K., Ahn, J. H., Yoon, H. J., Lee, D. I., et al. (2018) · International Journal of Arrhythmia · doi:10.18501/arrhythmia.2018.010 · Cited by 1 · see citing works

Synkope

von Scheidt, W., Klingenheben, T., & BOSCH, R. F. (2020) · Der Internist · doi:10.1007/s00108-020-00821-0 · Cited by 2 · see citing works

Syncope

Ungar, A., Rafanelli, M., Rivasi, G., & Marozzi, I. (2024) · Springer eBooks · doi:10.1007/978-3-030-74720-6_29 · Cited by 1 · see citing works

Utilidad de la midodrina para controlar el síncope vasovagal: ¿la recomienda la evidencia?

Picón‐Jaimes, Y. A., Toro-Gómez, D. M., Castillo-Restrepo, M., Sánchez-Estrada, L. F., Cárdenas-Bravo, D. F., Agámez, D. M. A., Gómez-Galán, M. A., Chamorro-Azuaje, T. J., & Salcedo-Pacheco, M. D. C. (2023) · Revista Investigación en Salud Universidad de Boyacá · doi:10.24267/23897325.890 · Cited by 1 · see citing works

Head-up tilt testing in older syncope patients: a systematic review

de Ruiter, S. C., van Marum, R. J., RUITER, J. H., Hemels, M. E. W., de Groot, J. R., & Jansen, R. W. M. M. (2025) · Age and Ageing · doi:10.1093/ageing/afaf086 · Cited by 1 · see citing works

Rethinking Tilt Testing

Sutton, R. (2016) · International Journal of Heart Rhythm · doi:10.4103/2352-4197.191478 · Cited by 1 · see citing works

New approach to hypotensive susceptibility in reflex syncope induced by tilt testingPreprint

Fedorowski, A., Rivasi, G., Torabi, P., Johansson, M., Rafanelli, M., Marozzi, I., Ceccofiglio, A., Casinini, N., Hamrefors, V., Ungar, A., et al. (2020) · doi:10.22541/au.160536789.94650193/v1 · Cited by 1 · see citing works

[Investigation in suspected syncope. A study of more than 1,174 consecutively referred patients].

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Tilt-table testing in syncope - our results

Bradić, L., Mihajlović, M., Crevar, A., Eder, G., Krželj, K., Jukić, T., Bitunjac, I., & Benčić, M. L. (2017) · Cardiologia Croatica · doi:10.15836/ccar2017.378

A doppler index for evaluating the effect of vasodilator therapy on aortic wave reflections

Miyashita, H., Tsuruya, Y., Ikeda, U., Sekiguchi, H., Shimada, K., & Yaginuma, T. (1994) · Pathophysiology · doi:10.1016/0928-4680(94)90665-3