Efficacy of tilt training in the treatment of neurally mediated syncope. A randomized study

Recurrent neurally mediated syncope represents a common clinical event and a therapeutic challenge. Recently tilt training has been proposed for the treatment of recurrent neurally mediated syncope. To evaluate the efficacy of tilt training in preventing tilt-induced syncope and its feasibility, this controlled, randomized study was undertaken. Sixty-eight consenting patients (25 mates and 43 females, mean age 40 +/- 19 years) with recurrent neurally mediated syncope and 2 consecutive positive nitroglycerin-potentiated head-up tilt tests were randomized to tilt training (35 patients) or no treatment (controls, 33 patients). The tilt training programme consisted of daily 30-min sessions of upright standing against a vertical wall 6 days a week for at least 3 weeks, until a reevaluation tilt test (3 patients of both groups dropped out). On this third head-up tilt test, 19 (59%) of 32 tilt trained patients and 18 (60%) of 30 controls still had a positive test. Treated patients performed a mean number of 15 7 sessions (median 16) and only 11 patients (34%) did all the programmed sessions. Only 1 patient (3%) discontinued treatment because of intolerance, while all other patients did not perform tilt training adequately, because of poor compliance. Thus, in our study tilt training was not effective in reducing tilt testing positivity rate in patients with neurally mediated syncope. Because of poor compliance, tilt training appears to be a feasible Recurrent neurally mediated syncope represents a common clinical event and a therapeutic challenge. Many pharmacological treatments have been proposed, but randomized, controlled studies gave conflicting results [1-6]. Pacemaker implantation has proved to be effective [7-9], but recently this issue has been questioned [10]. Recently tilt training has been proposed as a treatment for recurrent neurally mediated syncope [11, 12]. It was postulated that repeated orthostatic stress could be of benefit to the regulation of cardiovascular control mechanisms. No randomized studies are available concerning the efficacy of tilt training in the treatment of neurally mediated syncope. We have performed a prospective, randomized, multicentre, acute study to test the efficacy of tilt training in preventing tilt-induced syncope and a feasibility follow-up study.