Dynamic changes in T-wave and QTc interval during tilt table testing: Innocent until proven otherwise

A16-year-old female underwent tilt table testing, which resulted positive for reflex vasodepressive syncope. 12‑lead ECG during syncope showed T-wave inversion in infero-lateral leads, along with QTc interval increase >100 msec compared to baseline. These abnormalities rapidly disappeared in supine position with resumption of consciousness. Complete cardiac evaluation excluded heart disease. T-wave changes and moderate QTc prolongation are relatively common in young (mainly female) patients undergoing tilt table testing and they appear benign in nature. However, in a minority of cases, on the basis of the clinical context and after an accurate ECG analysis, further examinations may be warranted. •T-wave changes and moderate QTc prolongation on 12‑lead ECG are relatively common in young female patients who undergo tilt table testing.•We describe a 16-year-old female with syncopal episodes with a tilt table testing positive for reflex syncope with a vasodepressor response.•12‑lead ECG during syncope showed transient T-wave inversion in infero-lateral leads, along with QTc interval increase >100 msec. A complete cardiac evaluation excluded heart disease.•Data from literature suggest a benign nature of these ECG findings; further investigations are warranted only in a minority of cases.