Selección de lo mejor del año 2017 sobre la utilidad de la estimulación cardiaca en el tratamiento del síncope vasovagal / Selection of the best of 2017 on the usefulness of cardiac stimulation in the treatment of vasovagal syncope

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The role of tilt training in preventing recurrent syncope in patients with vasovagal syncope: a prospective and randomized study.

BACKGROUND: Recurrent vasovagal syncope (VVS) can be a severely disabling disorder that may lead to an important deterioration of quality of life because of the severity and recurrence of episodes. This study sought to investigate the effectiveness of repeated orthostatic self-training in preventing syncope in patients with recurrent VVS. METHODS: Eighty-two consecutive patients (mean age 41 +/- 4 years, 37 males) with recurrent VVS episodes and positive head-up tilt testing (HUT) were enrolled in this study. The patients were then randomized (1:1) to conventional therapy or conventional therapy plus additional tilt training sessions. The patients were followed for spontaneous syncope for one year. Primary end-points were the recurrence of syncope, the number of episodes, and the interval of time to the first recurrence. RESULTS: There were no significant differences of baseline clinical characteristics and parameters of HUT between the tilt training and control groups. The patients had 4 +/- 2/year syncopal episodes prior to the HUT. The mean follow-up after randomization was 12 +/- 2 months. Spontaneous syncope recurrence during follow-up was 56% (23 patients) versus 37% (15 patients) in the control and tilt training groups, respectively (P = 0.1). Time to first recurrence was also similar in both groups (70 +/- 20 days vs 50 +/- 15 days, P = 0.09). The frequency of recurrent syncopes was similar in all types of VVSs while the rate of episodes was significantly higher in control group in patients with vasodepressor type during follow-up period (32% vs 10%, P = 0.04). The mean number of recurrent syncope episodes was also similar in both groups (3 +/- 1 vs 2 +/- 1, P = 0.4). CONCLUSIONS: Tilt training was unable to influence the spontaneous syncope recurrence for recurrent VVS except for vasodepressor type.

Síncope neurocardiogênica e exercício / Neurocardiogenic syncope and exercise

A síncope neurocardiogênica acomete, na grande maioria das vezes, pessoas jovens, aparentemente normais, e que, com a recorrência de sintomas, passam a apresentar limitações quanto às atividades de vida diária e profissional. O tratamento convencional, realizado com bases nas medidas gerais(aumento da ingestão de líquidos, evitar situações desencadeantes e outras), e drogas, como beta-bloqueadores, fludrocortisona e inibidores de recaptação de serotonina, nem sempre é eficaz em diminuir a frequência e a intensidade dos episódios sincopais. Cada vez mais, buscam-se, em todo o mundo, medidas de caráter não farmacológico para minimizar a ocorrência de sintomas. Nesse aspecto, e com base na fisiopatologia das síncopes neuromediadas, recursos como o Tilt training e o treinamento físico apresentam-se como alternativa para abordagem, visto à maior aceitabilidade dos mesmos por parte dos pacientes, relutantes muitas vezes em fazer uso de medicação. Esse artigo busca, através de extensa revisão bibliográfica, discorrer sobre os diversos aspectos do exercício, relacionado-os à fisiopatologia e ao tratamento da síncope neurocardiogênica

Tilt training: a new treatment for recurrent neurocardiogenic syncope and severe orthostatic intolerance.

Medical treatment of neurocardiogenic syncope is insufficient in many cases. We have observed a therapeutic effect of repeated head-up tilt testing. Therefore, we have started a program of tilt training for heavily symptomatic patients. After hospital admission, they were tilted daily (60 degrees inclination) until syncope, or until a duration of 45-90 minutes (90 sessions in 13 patients). The mean tilt tolerance, at the first diagnostic head-up tilt table test, was 22.3 minutes (st. dev. 10.9). Before hospital discharge, 12/13 patients could sustain the full duration of tilt table testing without any symptom. In one patient syncope persisted. The patients were instructed to continue a program of daily tilt training at home, by standing against a wall for 30 minutes, one or two times per day. This resulted in a complete disappearance of syncope in all 13 patients. Orthostatic intolerance and the excessive autonomic reflex activity of neurocardiogenic syncope can be remedied by a program of continued tilt training, without the administration of drugs.