Ervín Müller, Peter Mitro, Miloš Šimurda, Lukáš Evin
Aim: Isometric counterpressure manoeuvres (ICM) are the first-line treatment in patients with vasovagal syncope (VVS)
and prodromes. The aim of the study was to compare the hemodynamic effect of each ICM and confirm their effectiveness
in prevention of spotaneous and head-up tilt (HUT) induced recurrences of VVS.
Methods: 24 patients (6 men, average age: 33,3±13,4 years old) without any structural heart disease and positive HUT
response were included. All patients participated in biofeedback training following ICM: squatting (SQ), leg crossing
with muscle tensing (LCMT), whole body tensing (WBT), heel raises (HR), toe extension (TE). Following hemodynamic
parameters were recorded by continous noninvasive monitoring: blood pressure (BP) [mmHg], heart rate (Hr) [bts/min],
cardiac output (CO) [l/min], stroke volume (SV) [ml], total peripheral resistane (TPR) [dyn.s/cm5]. After 3 months of daily
training of ICM 22 patients underwent control HUT. The effectiveness of ICM have been evaluated.
Results: All manoeuvres have increased mean arterial pressure (MAP) significantly [mmHg] (LCMT: 110 ± 10,3 vs.
130,3 ± 10,4, p < 0,001, WBT: 112,3 ± 10,1 vs. 129 ± 15,6, p < 0,001, HR: 112,3 ± 9,3 vs. 128 ± 8,8, p < 0,001 , TE: 112,2 ± 9
vs. 124,2 ± 11 p < 0,001, SQ: 111,7 ± 11,7 vs. 121,7 ± 12,5, p = 0,005). The hemodynamic background of the blood pressure
increase was increase of cardiac output (p < 0,05) [l/min]. TPR had not changed significantly. After 3 months
the vasovagal reaction was induced in 20 patients. The selected ICM was able to increase MAP (62 ± 13,3 mmHg vs.
100,5 ± 16,1 mmHg, p < 0,001) and CO (3,2 ± 1,1 l/min vs. 5,0 ± 1,5 l/min, p < 0,001) with significance. Applied ICM was
able to prevent syncope in the majority of patients (90%, n=18). During 3 months 1 patient had reccurence of syncope.
Conclusion: ICM have significant effect on hemodynamics and effectively counteract the development of HUT induced
– and spontaneous vasovagal reaction.