Home orthostatic training in vasovagal syncope modifies autonomic tone: results of a randomized, placebo-controlled pilot study

Tan, Maw Pin; Newton, Julia L.; Chadwick, Tom; Gray, Joanne; Nath, S; Parry, Steve W.

doi:10.1093/europace/eup368

Cited by 54 publications

(46 citation statements)

References 29 publications

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“…Previous studies have indicated that humoral mechanisms ---the renin---angiotensin system 20 , baroreflex changes, and overall autonomic alterations ---may be involved in the responses observed. 21---24 In particular, Verheyden et al 23 observed increased vasoconstrictor reserve without changes in baroreflex or autonomic tone, while Tan et al 24 showed increases in HF and LF indicators of increased autonomic tone. Our study is the first to relate hemodynamic changes to modifications in autonomic tone assessed by changes in BP and HR variability.…”

Section: Discussionmentioning

confidence: 99%

Tilt training increases vasoconstrictor reserve in patients with neurocardiogenic syncope

Laranjo¹,

Oliveira²,

Tavares³

et al. 2012

Revista Portuguesa de Cardiologia (English Edition)

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Neurocardiogenic syncope (NCS) is a common clinical entity resulting from an excessive reflex autonomic response, particularly during orthostatism. Treatment options are controversial and of limited effectiveness. Tilt training (TT) is a promising option to treat these patients. However, its mechanism of action and clinical impact remain unclear. Objective: To characterize hemodynamic and autonomic responses during a TT program in patients with NCS refractory to conventional measures. Methods: We studied 28 patients (50% male, mean age 41 ± 14 years) without structural heart disease, with NCS documented by tilt testing. The TT program included nine tilt sessions (three times a week, 30 min) (60 • ---6 sessions, 70 • ---3 sessions), under ECG and blood pressure monitoring combined with home orthostatic self-training and 10 • head-up during sleep. Systolic volume, cardiac output, total peripheral resistance, baroreflex sensitivity and heart-rate variability were computed. Patients were reassessed at 1 month and every 6 months for a maximum of 36 months (24 ± 12 months). Results: Over the course of the TT program there was a significant increase in total peripheral resistance (1485 ± 225 vs. 1591 ± 187 dyn s cm −5 , p < 0.05), with a decrease in standard deviation (206 ± 60 vs. 150 ± 42, p < 0.05). During follow-up, syncope recurred in five patients (19%), with a significant reduction in the number of episodes (4.0 ± 3.2/patient in the 12 months before TT vs. 1.4 ± 0.8/patient post-TT, p < 0.05). Conclusion:In refractory NCS, TT may be an effective therapeutic option, with long-term benefits. These results appear to be due to an increase in vasoconstrictor reserve combined with a reduction in its variance. PALAVRAS-CHAVE

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Section: Discussionmentioning

confidence: 99%

Tilt training increases vasoconstrictor reserve in patients with neurocardiogenic syncope

Laranjo¹,

Oliveira²,

Tavares³

et al. 2012

Revista Portuguesa de Cardiologia (English Edition)

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“…[19][20][21] One of the problems in interpreting the results of these trials was that there was low compliance in the group of patients allocated to tilt training. More recently, Tan and colleagues 22 published a blinded study of 22 patients in which the control group performed a sham maneuver, and those patients allocated to tilt training had fewer recurrences than those in the control group.…”

Section: Tilt Trainingmentioning

confidence: 99%

Therapy for Syncope

Moya¹

2015

Cardiology Clinics

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“…Tilt training, involving repeated orthostatic challenge either at home or with tilt table testing has proven helpful in highly motivated patients. In addition to symptomatic benefits, patients who tilt train show improvements in baroreflex sensitivity and heart rate variability compared to those who undergo sham training [55]. Evidence to support pharmacological management in VVS is limited and often conflicting.…”

Section: Vasovagal Syncopementioning

confidence: 99%