Tilt Training for Recurrent Neurocardiogenic Syncope: Effectiveness, Patient Compliance, and Scheduling the Frequency of Training Sessions

Abstract

SUMMARYUnsatisfactory results obtained with medical therapy and dual-chamber pacing for prevention of recurrent neurocardiogenic syncope necessitated the development of new treatment modalities. Tilt-training, a novel treatment for recurrent neurocardiogenic syncope based on exercise sessions with prolonged upright posture (either on a tilt-table or standing on foot against a wall), was shown to be effective in preventing the recurrence of neurocardiogenic syncope. The purpose of this study was to demonstrate the long-term beneficial effects of a transient tilt training program lasting 2 months.Thirty-two patients with recurrent neurocardiogenic syncope (mean number of syncope episodes in the last 6 months was 3.4 ± 2.3) constituted the study group. All of the patients were tilt test positive. The patients were taught a tilt training program with 2 phases (in-hospital training with repeated tilt procedures until 3 consecutive negative results were obtained and home exercises with standing against a wall) and home exercises lasted a maximum of 2 months. After this training program, the patients received no treatment and were followed for the recurrence of syncope. At the end of the follow-up period (376 ± 45 days), 81% of the patients were free of recurrent syncope.This study revealed that similar successful results can also be obtained with a transient tilt training program as a first line treatment strategy. Less interference with the daily activities of the patients is the major advantage of this strategy. The ease of performance and high effectiveness rate will most likely result in more frequent utilization of this treatment modality. (Jpn Heart J 2004; 45: 833-843) Key words: Recurrent neurocardiogenic syncope, Tilt training program RECURRENT neurocardiogenic syncope, which is defined as a sudden, transient loss of consciousness due to neurally-mediated hypotension and bradycarFrom the

Vestibular Activation Habituates the Vasovagal Response in the Rat

“…Our findings support the studies of Ector, Kinay, Reybrouck, and Di Girolamo (17, 18, 20, 21, 63), which habituated vasovagal syncope with static head-up tilt that would have activated otolith and body tilt receptors (23, 64). Habituation with head-up tilt takes significant time in the upright position and, therefore, would not involve the vertical semicircular canals.…”

“…An apparently promising therapy in which “syncope-sensitive” patients were repetitively tilted 60° for prolonged periods was originally shown to habituate the vestibulosympathetic reflex (VSR) and to reduce or abolish syncope (17–21). These studies used repeated episodes of 60° static head-up tilt or standing against a wall for substantial periods of time that activated otolith and body tilt receptors (22–24), both of which play a role in producing cardiovascular changes through the VSR in humans (25–29).…”

Ocena skuteczności zastosowania treningów pionizacyjnych oraz edukacji pacjenta w prewencji omdleń odruchowych u chorych z zespołem wazowagalnym, hospitalizowanych w Klinice Choroby Wieńcowej i Niewydolności Serca w latach 2010–2015

“…This may be confirmed by the observations of the effectiveness of TT sessions performed only periodically. Repeated procedures associated with performing in-hospital and home training of prolonged standing may play a key role in gaining the ability of early identification of prodromal symptoms, which in turn helps preventing syncope in everyday life [9].…”

Current concepts in the evaluation and management of syncope

“…Other acute studies are less encouraging. Kinay et al [ 28 ] performed repetitive tilt training in 32 patients. They found that although 20 responded by the second session, three were resistant even after eight attempts.…”