Efficacy and feasibility of isometric arm counter-pressure manoeuvres to abort impending vasovagal syncope during real life

Aims Isometric arm exercises are able to increase blood pressure during the phase of impending vasovagal syncope. We evaluated their efficacy and feasibility during daily life in a group of 29 consecutive patients affected by vasovagal syncopes. Methods The patients were trained to use arm tensing and/or handgrip in case of occurrence of symptoms of impending syncope. Results During 14+/-6 months of follow-up, 260 episodes of impending syncope were reported by 19 patients; the manoeuvres were self-administered by these patients in 98% of cases and were able to abort syncope in 99.6% of cases. Overall, 5 episodes of syncope occurred in 5 patients (17%), in 4 cases without and in 1 with activation of the manoeuvres. Syncope recurred in 4 (40%) of 10 patients aged > 65 years versus only 1 (5%) of 19 patients aged less than or equal to 65 years, p = 0.03. The non-responders had more episodes of impending syncope than responders (37+/-32 vs 3+/-4, p = 0.001). Among 19 clinical variables, age in years was the only significant predictor of syncopal recurrence. No patients had injury or other adverse morbidity related to the relapses. Conclusions Isometric arm counter-pressure manoeuvres are able to abort impending vasovagal syncope in most patients aged :! 65 years. Arm counter-pressure manoeuvres are feasible, safe and well accepted by the patients in the daily life. (C) 2004 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.