Usefulness of a tilt training program for the prevention of refractory neurocardiogenic syncope in adolescents - A controlled study

Background-Recurrent syncope represents a debilitating disorder and quality of life deteriorates as a function of recurrence of symptoms. Although the administration of beta-blockers, vasoconstrictors, fludrocortisone, and se rotonin reuptake inhibitors may be helpful in preventing episodes, many pat ients are intolerant of or respond poorly to these agents. Orthostatic trai ning has been reported to be effective in preventing refractory syncope. Th us, to determine whether a tilt training program could prevent symptoms in adolescents, the following controlled study was undertaken. Methods and Results-Forty-seven consecutive adolescents (18 male and 29 fem ale, mean age 16.0+/-2.2 years) with recurrent syncope and positive head-up tilt test refractory to previous traditional therapies were distributed be tween 2 groups, depending on their consent (24 patients) or refusal (contro ls, 23 patients) to enter the program. Orthostatic training was started, in the presence of a family member, with a series of 5 in-hospital sessions. The 24 patients and their relatives were then instructed to perform the til t training at home by standing against a wall twice a day for a planned dur ation of up to 40 minutes, depending on the in-hospital orthostatic toleran ce. Head-up tilt response was reevaluated after 1 month, and the clinical e ffect was noted over a mean follow-up of 18.2+/-5.3 months (range 15 to 23) ; 26.1% of patients in the control group and 95.8% of patients in the train ing group became tilt-negative (P<0.0001). Spontaneous syncope was observed in 56.5% versus 0% in the control and training group, respectively (P<0.00 01). Conclusions-Orthostatic training was found to significantly improve symptom s of adolescents with neurocardiogenic syncope unresponsive to or intoleran t of traditional medications. Twice-a-day training sessions of 40 minutes w ere well accepted by patients.