© 2004 by European Society of Cardiology
Efficacy of tilt training in the treatment of neurally mediated syncope. A randomized study
aDepartment of Cardiology of Ospedale Valduce Como, Italy; bDepartment of Cardiology of Ospedale Umberto I Mestre, Italy; cDepartment of Cardiology of Ospedale Civile Genova-Sampierdarena Italy; dDepartment of Cardiology of Ospedale S. Maria Annunziata Firenze, Italy; eDepartment of Cardiology of Ospedale S. Maria Nuova Reggio Emilia, Italy; fDepartment of Cardiology of Ospedale Civile Cento, Italy; gDepartment of Cardiology of Ospedale Civile Fucecchio, Italy; hDepartment of Cardiology of Ospedali Riuniti Lavagna, Italy
Recurrent neurally mediated syncope represents a common clinical event and a therapeutic challenge. Recently tilt training has been proposed for the treatment of recurrent neurally mediated syncope. To evaluate the efficacy of tilt training in preventing tilt-induced syncope and its feasibility, this controlled, randomized study was undertaken. Sixty-eight consenting patients (25 males and 43 females, mean age 40±19 years) with recurrent neurally mediated syncope and 2 consecutive positive nitroglycerin-potentiated head-up tilt tests were randomized to tilt training (35 patients) or no treatment (controls, 33 patients). The tilt training programme consisted of daily 30-min sessions of upright standing against a vertical wall 6 days a week for at least 3 weeks, until a reevaluation tilt test (3 patients of both groups dropped out). On this third head-up tilt test, 19 (59%) of 32 tilt trained patients and 18 (60%) of 30 controls still had a positive test. Treated patients performed a mean number of 15±7 sessions (median 16) and only 11 patients (34%) did all the programmed sessions. Only 1 patient (3%) discontinued treatment because of intolerance, while all other patients did not perform tilt training adequately, because of poor compliance. Thus, in our study tilt training was not effective in reducing tilt testing positivity rate in patients with neurally mediated syncope. Because of poor compliance, tilt training appears to be a feasible treatment only for highly motivated patients, but not for the majority of patients with recurrent neurally mediated syncope.
Key Words: neurally mediated syncope, tilt testing, tilt training, treatment
*Corresponding author. U. O. Cardiologia, Ospedale Valduce, Via Dante, 11, 22100 Como, Italy. Tel.: +39031324111; fax: +39031308047. E-mail address: gfoglia{at}valduce.it (G. Foglia-Manzillo).
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