Usefulness of orthostatic self-training for the prevention of neurocardiogenic syncope

To clarify the effectiveness of an orthostatic self-training program for the prevention of neurocardiogenic syncope, twenty-four consecutive head-up tilt induced syncopal patients (12 men, 12 women; mean age 34 +/- 20 years) were treated with an orthostatic self-training program. The syncope was induced by head-up tilt testing (+ 80 degrees for 30 minutes) with or without the use of isoproterenol in all patients reproducibly. The hemodynamics during the syncope were of the cardioinhibitory type in 4, vasodepressor type in 7, and mixed type in 13 patients. The onset time of the tilt induced syncope was 16 +/- 10 minutes after the upright position. The orthostatic self-training included standing against a wall without moving twice a day every day for a planned duration of up to 30 minutes at home. The head-up tilt response was reevaluated with the same protocol as the initial study after 22 +/- 6 days based on the patient's daily recording of the self-training, and the clinical effect of the training program performed only once a day at home was noted over a mean follow-up of 9.5 +/- 3.4 months (range 5-18 months). Tilt induced syncope after the self-training was observed in 2 of 24 patients. However, spontaneous syncope was not observed in any of the patients during follow-up. In conclusion, orthostatic self-training significantly improved the symptoms in patients with neurocardiogenic syncope. Once a day training for up to 30 minutes was effective and easily accepted by the patients for the prevention of neurocardiogenic syncope.