Tilt training: A treatment for malignant and recurrent neurocardiogenic syncope

The treatment of neurocardiogenic syncope is insufficient in many cases. We hypothesized that the repeated exposure of the cardiovascular system to or thostatic stress could have a therapeutic effect on the regulation of cardi ovascular reflex mechanisms. We have started a program of tilt training for heavily symptomatic patients. After hospital admission, patients were tilt ed daily (60-degree inclination), until syncope, or until a maxim um of 45- 90 minutes. The patients were instructed to continue a program of daily til t training at home: two 30-minute sessions of upright standing against a ve rtical wall. No medication was prescribed. A total of 260 tilt table sessio ns were performed in 42 patients. The first tilt test was positive after 21 +/- 13 minutes. The syncope was cardioinhibitory in 14 cases, vasodepresso r in 19, mixed in 9. At the time of hospital discharge, 42 patients could s upport 45 minutes of head-up tilting. After a mean follow-up time of 15.1 ( SD 7.8) months, 36 patients remained completely free of syncope. Syncope st ill occurred in one patient and presyncope in four patients. One patient di ed from an extensive myocardial infarction. The abnormal autonomic reflex a ctivity of neurocardiogenic syncope can be remedied by a program of continu ed tilt training without the administration of drugs. This new treatment ha s proven to be effective for the vasodepressor and the cardioinhibitory typ e of syncope.