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

doi:10.1093/europace/eup368

Europace Advance Access published online on November 17, 2009
Europace, doi:10.1093/europace/eup368

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CLINICAL RESEARCH

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

Maw Pin Tan¹, Julia L. Newton¹^,2, Tom J. Chadwick³, Janine C. Gray², Samiran Nath⁴ and Steve W. Parry¹^,2^,*

¹ Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK; ² Falls and Syncope Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK; ³ Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK; ⁴ Department of Cardiology, North Tyneside General Hospital, North Shields, UK

Aims: To detect possible autonomic changes due to home orthostatictraining (HOT) and to assess the feasibility of a larger, placebo-controlledstudy of HOT in vasovagal syncope (VVS).

Methods and results: Twenty-two consecutive patients, aged 18–85, diagnosedwith VVS following a positive head-up tilt-table test were randomizedto 40 min of HOT (n = 12) or 10 min of sham training (n = 10)daily for 6 months. Baroreflex sensitivity (BRS) and heart ratevariability (HRV) were measured at weeks 0, 1, 4, and 24. Symptomresponse was assessed by event diaries. Home orthostatic trainingresulted in increases in up and down slope BRS at week 4 (e^{log difference} = 1.59, 95% CI = 0.84–3.03 and 1.79, 95% CI= 1.00–3.22) and week 24 (e^{log difference} = 1.75, 95%CI = 1.01–3.06 and 1.53, 95% CI = 0.66–2.68) comparedwith placebo. Relative improvements in low- and high-frequencyHRV were also observed in the HOT group compared with placeboat week 4 (e^{log difference} = 3.22, 95% CI = 1.06–9.86and 3.19, 95% CI = 1.03–10.59) and week 24 (e^{log difference}= 2.11, 95% CI = 0.72–6.17 and 2.13, 95% CI = 0.52–8.79).Fifty percentage of HOT subjects and 20% of control subjectswere syncope-free at 6 months.

Conclusion: This was the first placebo-controlled study in orthostatic trainingwhich has demonstrated that such a study is indeed feasible.An enhancement in overall autonomic tone is observed with HOTin tandem with a non-significant trend in symptom improvement.A larger, adequately powered, randomized controlled trial oftilt-training is now needed.

Key Words: Vasovagal syncope, Autonomic nervous system, Tilt training, Heart rate variability, Baroreflex sensitivity

^* Corresponding author. Tel: +44 191 282 5237, Fax: +44 191 282 5338, Email: swparry{at}hotmail.com

Manuscript submitted 16 May 2009. Accepted after revision 21 October 2009.

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