title: Effects of orthostatic self-training on head-up tilt testing and autonomic balance in patients with neurocardiogenic syncope.
abstract: To investigate the effectiveness and the mechanisms of an orthostatic self-training program for the prevention of neurocardiogenic syncope, 28 patients were treated with an orthostatic self-training program. Syncope was induced by head-up tilt testing (+ 80 degrees for 30 min) in all patients. The onset time of the tilt-induced syncope was 14 +/- 7 min following placement in the upright position. The orthostatic self-training program included standing against a wall without moving twice a day every day for a planned duration of up to 30 min at home. The head-up tilt response was re-evaluated after 24 +/- 6 days based on results of the self-training. In 12 of the 28 patients, the sympathovagal balance was also determined during the head-up tilt test before and after the training with power spectral analysis of heart rate variability using a maximal entropy method. Syncope was not observed in any patient after the training. Although the low frequency/high frequency ratio in the supine position was not different before and after the training, the ratio after 3 min in the upright position after the training decreased significantly compared with that before the training. High-frequency components in the supine and upright positions were not different before and after the training. We concluded that orthostatic self-training significantly improved symptoms in patients with tilt-induced neurocardiogenic syncope. Decreased sympathetic activity in the early stage of the upright position period may play an important role in the mechanisms of this therapy.
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health, Yahatanishi, Kitakyushu, Japan. haru-abe@med.uoeh-u.ac.jp
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Abe
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Kohshi
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Nakashima
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D011187:Posture / Q000502:physiology*; D012648:Self Care / Q000379:methods*; D013575:Syncope / Q000503:physiopathology / Q000628:therapy; D019462:Syncope, Vasovagal / Q000503:physiopathology / Q000628:therapy*