title: Isometric arm counter-pressure maneuvers to abort impending vasovagal syncope.
abstract: OBJECTIVE
  We hypothesized that isometric arm exercises were able to increase blood pressure (BP) during the phase of impending vasovagal syncope and allow the patient to avoid losing consciousness.
  
  
  BACKGROUND
  Hypotension is always present during the prodromal phase of vasovagal syncope.
  
  
  METHODS
  We evaluated the effect of handgrip (HG) and arm-tensing in 19 patients affected by tilt-induced vasovagal syncope. The study consisted of an acute single-blind, placebo-controlled, randomized, cross-over tilt-table efficacy study and a clinical follow-up feasibility study.
  
  
  RESULTS
  In the acute tilt study, HG was administered for 2 min, starting at the time of onset of symptoms of impending syncope. In the active arm, HG caused an increase in systolic blood pressure (SBP) from 92 +/- 10 mm Hg to 105 +/- 38 mm Hg, whereas in the placebo arm SBP decreased from 91 +/- 11 mm Hg to 73 +/- 21 mm Hg (p = 0.008). Heart rate behavior was similar in the two arms. In the active arm, 63% of patients became asymptomatic, versus 11% in the control arm (p = 0.02); conversely, only 5% of patients developed syncope, versus 47% in the control arm (p = 0.01). The patients were trained to self-administer arm-tensing treatment as soon as symptoms of impending syncope occurred. During 9 +/- 3 months of follow-up, the treatment was actually performed in 95/97 episodes of impending syncope (98%) and was successful in 94/95 (99%). No patients suffered injury or other adverse morbidity related to the relapses.
  
  
  CONCLUSIONS
  Isometric arm contraction is able to abort impending vasovagal syncope by increasing systemic BP. Arm counter-pressure maneuvers can be proposed as a new, feasible, safe, and well accepted first-line treatment for vasovagal syncope.
authors.affiliation: Arrhythmologic Centre, Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy. mbrignole@ASL4.liguria.it
authors.forename: Michele
authors.initials: M
authors.lastname: Brignole
authors.forename: Francesco
authors.initials: F
authors.lastname: Croci
authors.forename: Carlo
authors.initials: C
authors.lastname: Menozzi
authors.forename: Alberto
authors.initials: A
authors.lastname: Solano
authors.forename: Paolo
authors.initials: P
authors.lastname: Donateo
authors.forename: Daniele
authors.initials: D
authors.lastname: Oddone
authors.forename: Enrico
authors.initials: E
authors.lastname: Puggioni
authors.forename: Gino
authors.initials: G
authors.lastname: Lolli
mesh_terms: D000293:Adolescent; D000328:Adult; D001132:Arm / Q000098:blood supply* / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D003971:Diastole / Q000502:physiology; D017097:Electric Impedance; D022062:Electrophysiologic Techniques, Cardiac; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007537:Isometric Contraction / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D015203:Reproducibility of Results; D019462:Syncope, Vasovagal / Q000503:physiopathology*; D013599:Systole / Q000502:physiology; D018667:Tilt-Table Test