RT-36
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Tilt training: a new treatment
for recurrent neurocardiogenic syncope and severe orthostatic intolerance
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Hugo Ector, Tony Reybrouck*°,
Hein Heidbüchel, Marc Gewillig*, Frans Van de Werf.
Departments of Cardiology, *Pediatric Cardiology and °Cardiovascular Rehabilitation,
University Hospital Gasthuisberg, Leuven, Belgium
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Abstract
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Medical treatment of neurocardiogenic syncope is
insufficient in many cases. We have observed a therapeutic effect of repeated head-up tilt
testing. Therefore, we have started a program of tilt training for heavily symptomatic
patients. After hospital admission, they were tilted daily (60° inclination) until
syncope, or until a duration of 45-90 minutes (90 sessions in 13 patients). The mean tilt
tolerance, at the first diagnostic head-up tilt table test, was 22.3 minutes (SD 10.9).
Before hospital discharge, 12/13 patients could sustain the full duration of tilt table
testing without any symptom. In one patient syncope persisted. The patients were
instructed to continue a program of daily tilt training at home, by standing against a
wall for 30 minutes, one or two times per day. This resulted in a complete disappearance
of syncope in all 13 patients.
Orthostatic intolerance and the excessive autonomic reflex activity of
neurocardiogenic syncope can be remedied by a program of continued tilt training, without
the administration of drugs.
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Key Words
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Syncope
head-up tilt testing, orthostatic intolerance, tilt training, OA
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