Tilt-Induced Syncope

To the Editor: We were gratified to see further attention drawn by the paper of Almquist et al. (Feb. 9 issue) ¹ to the important area of orthostatic stress testing for the induction of vasovagal syncope in patients with unexplained syncope. In our practice, we favor the term “malignant vasovagal syndrome,”² because the features of tilt-induced syncope — bradycardia and hypotension as a result of vasodilatation — reproduce the patient's symptoms. Tilt-induced syncope fits the original description of vasovagal syncope by Lewis.³ The period of tilt recommended by Almquist et al. is only 10 minutes. We began by routinely tilting patients…