CLINICAL STUDY
Isometric arm counter-pressure maneuvers to abort impending vasovagal syncope
Michele Brignole, MD*,*,
Francesco Croci, MD*,
Carlo Menozzi, MD ,
Alberto Solano, MD*,
Paolo Donateo, MD*,
Daniele Oddone, MD*,
Enrico Puggioni, MD* and
Gino Lolli, MD
* Arrhythmologic Centre, Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy
Service of Interventional Cardiology, Department of Cardiology, Ospedale S Maria Nuova, Reggio Emilia, Italy
Manuscript received September 11, 2002;
revised manuscript received October 7, 2002,
accepted October 10, 2002.
* Reprint requests and correspondence: Dr. Michele Brignole, Department of Cardiology, Ospedali del Tigullio, Via don Bobbio, 16033 Lavagna, Italy.
mbrignole{at}ASL4.liguria.it
OBJECTIVES: 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.
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Abbreviations and Acronyms
| | BP | | blood pressure | | DBP | | diastolic blood pressure | | ECG | | electrocardiogram | | HG | | handgrip | | HR | | heart rate | | SBP | | systolic blood pressure |
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