Effects of orthostatic self-training on head-up tilt testing for the prevention of tilt-induced neurocardiogenic syncope: comparison of pharmacological therapy.

Although a wide variety of medical treatments for neurocardiogenic syncope have been proposed, therapy has largely been emperic based on the mechanisms commonly believed to lead to neurocardiogenic fainting. To determine the utility and efficacy of drug therapy and an orthostatic self-training program in the prevention of tilt-induced neurocardiogenic syncope, we investigated 43 consecutive patients who had shown syncope and were induced by head-up tilt test reproducibly, with either traditional medical treatments or orthostatic self-training at home. The initial 19 of 43 patients were treated with either oral propranolol or disopyramide therapies. The remaining 24 patients were treated with an orthostatic self-training program alone. Effects of these therapies on head-up tilt test were reevaluated in all patients. Propranolol prevented syncope in only six (32%) and disopyramide in five (26%) of the 19 patients. There was no significant difference in the effectiveness between them. Syncope was prevented in nine (47%) patients with either propanolol or disopyramide therapy alone, while in the remaining 10 patients it was not. On the other hand, orthostatic self-training program prevented syncope in 22 (92%) of 24 patients. We concluded that orthostatic self-training program is far more effective than traditional drug therapies. Orthostatic self-training is an effective, safe and well accepted therapy in the prevention of tilt-induced neurocardiogenic syncope.