A patient treated with tilt training and midodrine after 68 seconds asystole during head-up tilt table testing

Area of Science:

• Cardiology
• Neurology

Background:

• Neurocardiogenic syncope is a frequent cause of syncope, often diagnosed via head-up tilt testing.
• Recurrent episodes can significantly impact quality of life.

Observation:

• A 21-year-old male presented with recurrent syncope, triggered by venipuncture and prolonged standing.
• Syncope occurred during head-up tilt table testing, with sinus rhythm returning after 68 seconds.

Findings:

• The patient received a combination therapy of midodrine (2.5 mg daily) and a structured tilt training program.
• This therapeutic approach led to significant clinical improvement.

Implications:

• Tilt training, combined with pharmacotherapy like midodrine, offers an effective strategy for managing recurrent neurocardiogenic syncope.
• A six-month follow-up revealed no major adverse events, suggesting sustained therapeutic benefit.