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Home orthostatic training in vasovagal syncope modifies autonomic tone: results of a randomized, placebo-controlled pilot study

Lookup NU author(s): Dr Maw Tan, Emerita Professor Julia Newton, Dr Thomas Chadwick, Dr Janine Gray, Dr Steve Parry



To detect possible autonomic changes due to home orthostatic training (HOT) and to assess the feasibility of a larger, placebo-controlled study of HOT in vasovagal syncope (VVS). Twenty-two consecutive patients, aged 18-85, diagnosed with VVS following a positive head-up tilt-table test were randomized to 40 min of HOT (n = 12) or 10 min of sham training (n = 10) daily for 6 months. Baroreflex sensitivity (BRS) and heart rate variability (HRV) were measured at weeks 0, 1, 4, and 24. Symptom response was assessed by event diaries. Home orthostatic training resulted in increases in up and down slope BRS at week 4 (e(log difference) = 1.59, 95% CI = 0.84-3.03 and 1.79, 95% CI = 1.00-3.22) and week 24 (e(log difference) = 1.75, 95% CI = 1.01-3.06 and 1.53, 95% CI = 0.66-2.68) compared with placebo. Relative improvements in low- and high-frequency HRV were also observed in the HOT group compared with placebo at week 4 (e(log difference) = 3.22, 95% CI = 1.06-9.86 and 3.19, 95% CI = 1.03-10.59) and week 24 (e(log difference) = 2.11, 95% CI = 0.72-6.17 and 2.13, 95% CI = 0.52-8.79). Fifty percentage of HOT subjects and 20% of control subjects were syncope-free at 6 months. This was the first placebo-controlled study in orthostatic training which has demonstrated that such a study is indeed feasible. An enhancement in overall autonomic tone is observed with HOT in tandem with a non-significant trend in symptom improvement. A larger, adequately powered, randomized controlled trial of tilt-training is now needed.

Publication metadata

Author(s): Tan MP, Newton JL, Chadwick TJ, Gray JC, Nath S, Parry SW

Publication type: Article

Publication status: Published

Journal: Europace

Year: 2010

Volume: 12

Issue: 2

Pages: 240-246

Date deposited: 25/08/2010

ISSN (print): 1099-5129

ISSN (electronic): 1532-2092

Publisher: Oxford University Press


DOI: 10.1093/europace/eup368


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