Role of Baroreflex Sensitivity in Predicting Tilt Training Response in Patients with Neurally Mediated Syncope

PURPOSE: An association between baroreflex sensitivity (BRS) and the response to tilt training has not been reported in patients with neurally mediated syncope (NMS). This study sought to investigate the role of BRS in predicting the response to tilt training in patients with NMS. MATERIALS AND METHODS: We analyzed 57 patients who underwent tilt training at our hospital. A responder to tilt training was defined as a patient with three consecutive negative responses to the head-up tilt test (HUT) during tilt training. RESULTS: After tilt training, 52 patients (91.2%) achieved three consecutive negative responses to the HUT. In the supine position before upright posture during the first session of tilt training for responders and non-responders, the mean BRS was 18.17+/-10.09 ms/mm Hg and 7.99+/-5.84 ms/mm Hg (p=0.008), respectively, and the frequency of BRS > or =8.945 ms/mm Hg was 45 (86.5%) and 1 (20.0%; p=0.004), respectively. Age, male gender, frequency of syncopal events before HUT, type of NMS, phase of positive HUT, total number of tilt training sessions, and mean time of tilt training did not differ between the study groups. In the multivariate analysis, BRS <8.945 ms/mm Hg in the supine position (odds ratio 23.10; 95% CI 1.20-443.59; p=0.037) was significantly and independently associated with non-response to tilt training. CONCLUSION: The BRS value in the supine position could be a predictor for determining the response to tilt training in patients with NMS who are being considered for inpatient tilt training.

Long-term Follow-up Results of Tilt Training in Patients with Neurocardiogenic Syncope

BACKGROUND AND OBJECTIVES: Tilt training as a non pharmacological therapy was recently introduced to treat the patients with neurocardiogenic syncope. Tilt training has been known to prevent neurocardiogenic syncope by desensitizing abnormal autonomic reflex. Herein, the early effect of tilt training and the preventive effect on the relapse of syncope were studied during a long-term follow-up period. SUBJECTS AND METHODS: Fifteen patients (11 males) who experienced recurrent syncope, despite drug treatment or were intolerant to drug treatment, among those diagnosed as neurocardiogenic syncope by the head-up tilt test at Samsung Medical Center between March 2000 and May 2003 were recruited. Each patient underwent tilt training after admission and was educated to continue self-tilt training after discharge. Data for recurrences after discharge were obtained via questionnaires on outpatient visits or by telephone interviews. RESULTS: Eleven (73%) of the 15 who underwent tilt training on admission showed therapeutic effects. The mean follow-up period was 21+/-10 months (5-40 months). Only one patient was excluded due to follow-up loss. Ten of the above patients underwent training by themselves for an average of 4 months after discharge, and experience no relapse of syncope during the follow-up period. CONCLUSION: Tilt training maintained its therapeutic effect during long-term follow-up. This could be a new treatment for patients non responsive or intolerant to medical therapy.

Usefulness of tilt training in patients with neurocardiogenic syncope

Neurocardiogenic syncope is a relatively common cause of syncope and is diagnosed by head-up tilt test. A wide variety of medical treatment has been proposed, such as beta-blocker, vasoconstrictor, fludrocortisone, and serotonin re-uptake inhibitors. But there are some cases in which these therapies have failed to prevent syncope. Recent report has shown that tilt training is a very effective therapy for recurrent neurocardiogenic syncope. Thus, to determine whether tilt training could prevent symptoms in the patients with recurrent neurocardiogenic syncope, the following study was taken. Five patients diagnosed with neurocardiogenic syncope by head-up tilt test were included. After hospital admission, they were tilted daily until negative response occurred. Negative response was noted in four patients. But tilt training was stopped in one patient because of no response of tilt training. After hospital discharge, the four patients performed tilt training at home by leaning against wall. They were interviewed on the phone eight to eleven months later. They have not experienced any symptoms during the follow-up period. This is the first domestic report of tilt training in patients with neurocardiogenic syncope.