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.
|
Abbreviations and Acronyms
| | BP | | blood pressure | | DBP | | diastolic blood pressure | | ECG | | electrocardiogram | | HG | | handgrip | | HR | | heart rate | | SBP | | systolic blood pressure |
|
This article has been cited by other articles:
|
|
|
|
 
Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), Endorsed by the following societies, European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al.
Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)
Eur. Heart J.,
November 1, 2009;
30(21):
2631 - 2671.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. G. Benditt and J. T. Nguyen
Syncope: therapeutic approaches.
J. Am. Coll. Cardiol.,
May 12, 2009;
53(19):
1741 - 1751.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Y. Chen, D. G. Benditt, and W.-K. Shen
Management of Syncope in Adults: An Update
Mayo Clin. Proc.,
November 1, 2008;
83(11):
1280 - 1293.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Petkar and A. Fitzpatrick
Tilt-table testing: transient loss of consciousness discriminator or epiphenomenon?
Europace,
June 1, 2008;
10(6):
747 - 750.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. P. Tan and S. W. Parry
Vasovagal syncope in the older patient.
J. Am. Coll. Cardiol.,
February 12, 2008;
51(6):
599 - 606.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Reybrouck and H. Ector
Exercise training and baroreflex sensitivity in patients with neurally mediated syncope
Eur. Heart J.,
November 2, 2007;
28(22):
2697 - 2698.
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. van Dijk, F. Quartieri, J.-J. Blanc, R. Garcia-Civera, M. Brignole, A. Moya, W. Wieling, and on behalf of the PC-Trial Investigators
Effectiveness of Physical Counterpressure Maneuvers in Preventing Vasovagal Syncope: The Physical Counterpressure Manoeuvres Trial (PC-Trial)
J. Am. Coll. Cardiol.,
October 17, 2006;
48(8):
1652 - 1657.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. T. P. Krediet, J. J. van Lieshout, L. W. J. Bogert, R. V. Immink, Y.-S. Kim, and W. Wieling
Leg crossing improves orthostatic tolerance in healthy subjects: a placebo-controlled crossover study
Am J Physiol Heart Circ Physiol,
October 1, 2006;
291(4):
H1768 - H1772.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Sheldon, S. Connolly, S. Rose, T. Klingenheben, A. Krahn, C. Morillo, M. Talajic, T. Ku, F. Fouad-Tarazi, D. Ritchie, et al.
Prevention of Syncope Trial (POST): A Randomized, Placebo-Controlled Study of Metoprolol in the Prevention of Vasovagal Syncope
Circulation,
March 7, 2006;
113(9):
1164 - 1170.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. T. P. Krediet, I. G. J. M. de Bruin, K. S. Ganzeboom, M. Linzer, J. J. van Lieshout, and W. Wieling
Leg crossing, muscle tensing, squatting, and the crash position are effective against vasovagal reactions solely through increases in cardiac output
J Appl Physiol,
November 1, 2005;
99(5):
1697 - 1703.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. P. Grubb
Neurocardiogenic Syncope
N. Engl. J. Med.,
March 10, 2005;
352(10):
1004 - 1010.
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. van Dijk, I. G. J. M. de Bruin, J. Gisolf, H. A. C. M. R. de Bruin-Bon, M. Linzer, J. J. van Lieshout, and W. Wieling
Hemodynamic effects of leg crossing and skeletal muscle tensing during free standing in patients with vasovagal syncope
J Appl Physiol,
February 1, 2005;
98(2):
584 - 590.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Ector, R. Willems, H. Heidbüchel, and T. Reybrouck
Repeated tilt testing in patients with tilt-positive neurally mediated syncope
Europace,
January 1, 2005;
7(6):
628 - 633.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Raviele, F. Giada, C. Menozzi, G. Speca, S. Orazi, G. Gasparini, R. Sutton, M. Brignole, and for the Vasovagal Syncope and Pacing Trial Investi
A randomized, double-blind, placebo-controlled study of permanent cardiac pacing for the treatment of recurrent tilt-induced vasovagal syncope. The vasovagal syncope and pacing trial (SYNPACE)
Eur. Heart J.,
October 1, 2004;
25(19):
1741 - 1748.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. O. Cheng, C.-C. Lu, C.-S. Tung, A. Diedrich, S. Y. Paranjape, P. A. Harris, D. W. Byrne, D. Robertson, and J. Jordan
Simple Self-Help Maneuvers Are Effective in Aborting Vasovagal Syncope * Response
Circulation,
May 11, 2004;
109(18):
e217 - e217.
[Full Text]
[PDF]
|
|
|
|
