Miloš Šimurda, Peter Mitro, Ervín Müller
Aims: The mechanism of the beneficial effect of tilt training in the prevention of recurrence of vasovagal syncope is unclear.
The aim of the work was to investigate the clinical effect of tilt training and describe its effect on baroreflex sensitivity
in patients with recurrent vasovagal syncope.
Study population and methods: The study included 35 patients with recurrent vasovagal syncope and positive head-up
tilt test who remained symptomatic despite an increased intake of fluids and salt. 15 patients were lost during follow
-up, 4 patients were excluded from the study for lack of compliance with tilt training. 16 patients (6 men / 10 women)
with a mean age of 38.38 ± 15.2 years performed home tilt training for 6 months and recorded all presyncopal and syncopal
recurrences. Baroreflex sensitivity was assessed by the non-invasive continuous blood pressure measurement
for 5 minutes during controlled breathing. The baroreflex sensitivity measurements were performed before and after
Results: The recurrence of syncope occurred in 2 patients, 12 patients had recurrence of presyncope. The total number of
syncope and presyncope episodes after tilt training was significantly reduced (2.63 ± 2.03 episodes/year vs. 0.125 ± 0.34
episodes/year, p < 0.0001; 10.02 ± 7.69 episodes/year vs. 2.81 ± 3.85 episodes/year, p = 0.0081, respectively). There was
no significant effect of tilt training on baroreflex sensitivity (supine position: 15,19±12,51 ms/mmHg vs. 15,05 ± 8,48
ms/mmHg, p = 0,48; sitting position: 9,79 ± 3,75 ms/mmHg vs. 10,51 ± 4,72 ms/mmHg, p = 0,32; upright position: 6,29
± 2,05 ms/mmHg vs. 6,65 ± 2,33 ms/mmHg, p = 0,35).
Conclusion: Tilt training performed once daily for 6 months significantly reduced the number of syncopal and presyncopal
episodes in patients with vasovagal syncope. Compliance to tilt training was relatively low. Effect of tilt training on
baroreflex sensitivity was not observed, suggesting a different mechanism of positive effect of this training.