Is Home Orthostatic Self‐Training Effective in Preventing Neurally Mediated Syncope?

On, Young Keun; Park, R N Jungwae; Huh, June; M.D., June Soo Kim

doi:10.1111/j.1540-8159.2007.00725.x

Cited by 72 publications

(31 citation statements)

References 22 publications

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“…& Foglia-Manzillo et al [15] evaluated tilt training and used a positive HUT as outcome. On et al [16] demonstrated similar follow-up HUT responses and no differences in the occurrence of spontaneous syncope or presyncope between the two groups. Home orthostatic selftraining was also found to be ineffective in the study conducted by Duygu et al [17].…”

Section: Tilt Trainingmentioning

confidence: 61%

“…Although the prescription of tilt training in highly motivated young patients with recurrent VVS may reduce the recurrence of syncope [13,14], three randomized controlled trials failed to confirm shortterm effectiveness in preventing tilt-induced VVS and reducing longterm syncope recurrence [15,16,17]. & Foglia-Manzillo et al [15] evaluated tilt training and used a positive HUT as outcome.…”

Section: Tilt Trainingmentioning

confidence: 98%

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Treatment of Vasovagal Syncope: An Update

Armaganijan

Morillo

2010

Curr Treat Options Cardio Med

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Vasovagal syncope (VVS) remains the most common cause of syncope and transient loss of consciousness in all age groups. The treatment of VVS focuses on measures that interrupt or prevent its pathophysiologic mechanism, as well as on avoidance of triggers. Although the evidence supporting an increase in salt and water intake is weak, it is a cost-effective and safe strategy that should always be used as first-line therapy. Patients should be educated on how to respond to further episodes of syncope, especially if they experience prodromal warning signs. In these cases, counterpressure maneuvers in younger patients are clearly effective. Orthostatic training exercises may improve symptoms in patients with recurrent VVS; however, this strategy is only effective in younger, highly motivated patients. Multiple medications have been tested in small trials, and there is sparse evidence on efficacy. β-Adrenergic antagonists and selective serotonin reuptake inhibitors have shown contradictory results on efficacy in a variety of studies; thus, their use should be restricted. Midodrine is the only drug proven to prevent VVS recurrence; however, no consistent prescription guidelines exist. The ongoing Second Prevention of Syncope Trial (POST II) is investigating the benefits of fludrocortisone in this population. In the meantime, measures such as increased salt and water intake and counterpressure maneuvers should be used in all cases if no contraindications are present. Pharmacologic treatment should be restricted to midodrine and fludrocortisone, with the other treatments as options in highly refractory cases. Implantation of a permanent pacemaker should be a measure of last resort in highly refractory cases, particularly in the cardioinhibitory type of VVS.

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Section: Tilt Trainingmentioning

confidence: 61%

Section: Tilt Trainingmentioning

confidence: 98%

Treatment of Vasovagal Syncope: An Update

Armaganijan

Morillo

2010

Curr Treat Options Cardio Med

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“…17) Some previous studies regarded head-up tilt testing as the endpoint and thus obtained a distinctively different or even opposite conclusion. 18,19) This may be due to differences in the diagnostic tilt testing protocol. Some positive results can only be obtained by pharmacological stimulation, and thus the specificity of head-up tilt testing is greatly reduced.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Orthostatic Training in the Prevention of Vasovagal Syncope and Its Influencing Factors

Zeng

Wei-lun

et al. 2008

Int. Heart J.

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SUMMARYRecently orthostatic training has been proposed as an effective treatment for vasovagal syncope, even though some patients may relapse. This study was undertaken to assess the effect of orthostatic training on patients with vasovagal syncope and its influencing factors.The study group comprised 125 consecutive patients (51 males and 74 females), aged 40 ± 19 years, with a history of syncope and a positive head-up tilt test. They were randomized into an orthostatic training group (64 patients) and a no treatment group (controls, 61 patients). The training programme consisted of daily 30-minute sessions of upright standing against a vertical wall 6 days a week for at least 4 weeks.After one year of follow-up, 45 (72.6%) of 62 orthostatic trained patients reported no syncopal recurrence, while only 22 of 61 controls (36.1%, P < 0.05) reported the same. Furthermore, in the training group, the patients with recurrence were older, and the number of syncopal spells in the preceding year was less than in the patients with no recurrence in the same group.Orthostatic training is an effective therapy for the prevention of vasovagal syncope. This kind of therapy was of greater benefit to patients who were younger or experienced frequent spells of syncope. (Int Heart J 2008; 49: 707-712)

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“…Leider haben Patienten ohne Prodromi keine Gelegenheit hierzu. Daher erscheint den ESC-LL-Autoren insbesondere für diese Patienten das Stehtraining (IIb-B-Empfehlung) trotz fragwürdigen Langzeitnutzens erwägenswert [9,12,18,19]. Zu wenig betont werden aus Sicht der Kommentatoren in der Therapie der Reflexsynkopen erhöhte Volumenzufuhr oder -retention, salzreiche Kost und ggf.…”

Section: Therapie Der Reflexsynkopen Und Der Orthostatischen Hypotonieunclassified

Kommentar zu der Leitlinie zur Diagnostik und Therapie von Synkopen der Europäischen Gesellschaft für Kardiologie 2009

et al. 2011

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Is Home Orthostatic Self‐Training Effective in Preventing Neurally Mediated Syncope?

Abstract: Home orthostatic self-training was ineffective in reducing the positive response rate of head-up tilt test in patients with recurrent neurally mediated syncope.

Cited by 72 publications

References 22 publications

Treatment of Vasovagal Syncope: An Update

Treatment of Vasovagal Syncope: An Update

The Effect of Orthostatic Training in the Prevention of Vasovagal Syncope and Its Influencing Factors

Kommentar zu der Leitlinie zur Diagnostik und Therapie von Synkopen der Europäischen Gesellschaft für Kardiologie 2009

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