EVALUATION OF THE VALUE OF HEAD-UP TILT FEEDBACK TRAINING IN PATIENTS WITH VASOVAGAL SYNCOPE
The aim of study: analysis of the usefulness of head-up tilt feedback training in comparison to classical tilt training in the treatment of patients with vasovagal syncope.
Study population: we observed 120 pts (77 women) aged 18-55 (median of age - 23,1 yrs) , with vasovagal syncope (VVS) confirmed by head-up tilt test (HUTT).
Methods: All pts underwent HUTT performed according Italian protocol. After positive HUTT result patient were randomly enrolled to one of two method of tilt training. Half of the patents were referred to classical tilt training proposed by H. Ector – repeated tilting until achieving two consecutive negative responses. The rest of patients were referred to head-up tilt feedback training. This method is based on combination of the tilt training with conterpressure manoeuvres feedback training during tilting performing twice per day. When the patients achieved the good tolerance of passive orthostatic tolerance, the NTG provocation (like in Italian protocol of HUTT) was managed, and the training was continued to protocol of training completion (20 min of tilting and 15 minutes after sl. NTG administration) without syncope. Both methods of training were introduced in hospital, after achieving the sufficient tolerance of orthostatic stress, the treatment was continued by typical ambulatory tilt training by 30 min every day. We assessed the 6-mounth effectiveness of both methods as well as the time to achieve the sufficient orthostatic tolerance (hospitalization time).
Results: Mean hospitalisation time was a little bit longer in patients treated with typical tilt training in comparison to tilt training with conterpressure manoeuvres feedback training (4,7 vs. 3,1 days. P<0,05). The 6-month effectiveness of treatment was comparable in both methods of treatment: syncope recurrence was observed in 16 % of pts. after tilt training and 14,5 % after conterpressure manoeuvres feedback training. Patients compliance to the treatment (ambulatory tilt training) was comparable (68 vs 65%, NS).
Conclusions: Head-up tilt feedback training seems to as effective as classical tilt training in the treatment of vasovagal syncope. Head-up tilt feedback training may lead to shortening of hospitalisation time necessary for initiaton such treatment of vasovagal syncope.