CLINICAL RESEARCH: SYNCOPE
Effectiveness of Physical Counterpressure Maneuvers in Preventing Vasovagal Syncope
The Physical Counterpressure Manoeuvres Trial (PC-Trial)
Nynke van Dijk, MD*,*,
Fabio Quartieri, MD ,
Jean-Jaques Blanc, MD ,
Roberto Garcia-Civera, MD ,
Michele Brignole, MD||,
Angel Moya, MD¶,
Wouter Wieling, MD, PhD* on behalf of the PC-Trial Investigators
* Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands
Department of Interventional Cardiology, Ospedale S. Maria Nuova, Reggio Emilia, Italy
Department of Cardiology, Hospital de la Cavale Blanche, Brest Cedex, France
Department of Cardiology, Hospital Clinico Universitario Valencia, Valencia, Spain
|| Department of Cardiology, Ospedali del Tigullio, Lavanga, Italy
¶ Department of Cardiology, Hospital General Vall d’Hebron, Barcelona, Spain.
Manuscript received April 20, 2006;
revised manuscript received June 6, 2006,
accepted June 19, 2006.
* Reprint requests and correspondence: Dr. Nynke van Dijk, Department of Internal Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. (Email: n.vandijk{at}amc.uva.nl).
OBJECTIVES: In this study, we assessed the effectiveness of physical counterpressure maneuvers (PCM) in daily life.
BACKGROUND: There is presently no evidence-based therapy for vasovagal syncope. Current treatment consists of explanation and life-style advice. Physical counterpressure maneuvers have been shown to raise blood pressure and to control or abort vasovagal episodes in laboratory conditions.
METHODS: We performed a multicenter, prospective, randomized clinical trial, which included 223 patients age 38.6 (±15.4) years with recurrent vasovagal syncope and recognizable prodromal symptoms. One hundred and seventeen patients were randomized to standardized conventional therapy alone, and 106 patients received conventional therapy plus training in PCM.
RESULTS: The median yearly syncope burden during follow-up was significantly lower in the group trained in PCM than in the control group (p = 0.004). During a mean follow-up period of 14 months, overall 50.9% of the patients with conventional treatment and 31.6% of the patients trained in PCM experienced a syncopal recurrence (p = 0.005). Actuarial recurrence-free survival was better in the treatment group (log-rank p = 0.018), resulting in a relative risk reduction of 39% (95% confidence interval, 11% to 53%). No adverse events were reported.
CONCLUSIONS: Physical counterpressure maneuvers are a risk-free, effective, and low-cost treatment method in patients with vasovagal syncope and recognizable prodromal symptoms, and should be advised as first-line treatment in patients presenting with vasovagal syncope with prodromal symptoms. (The PC-Trial; http://www.controlled-trials.com/isrctn/trial/45146526/0/45146526.html; ISRCTN45146526
[controlled-trials.com]
)
|
Abbreviations and Acronyms
| | ESC = European Society of Cardiology | | PCM = physical counterpressure maneuvers | | PC-Trial = Physical Counterpressure Manoeuvres Trial |
|
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]
|
|
|
|
|
|
|
S W Parry, P Reeve, J Lawson, F E Shaw, J Davison, M Norton, R Frearson, S Kerr, and J L Newton
The Newcastle protocols 2008: an update on head-up tilt table testing and the management of vasovagal syncope and related disorders
Heart,
March 1, 2009;
95(5):
416 - 420.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Brignole, J.-J. Blanc, R. Sutton, and A. Moya
CHAPTER 26 Syncope
ESC Textbook of Cardiovascular Medicine,
January 1, 2009;
2(1):
med-9780199566990-chapter - med-9780199566990-chapter.
[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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
M. Brignole, F. Giada, A. Raviele, and J. J. Blanc
Pacing for syncope: what role? which perspective?
Eur. Heart J. Suppl.,
December 1, 2007;
9(suppl_I):
I37 - I43.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. T Evans
Physical counterpressure manoeuvres reduced vasovagal syncope
Evid. Based Med.,
April 1, 2007;
12(2):
44 - 44.
[Full Text]
[PDF]
|
|
|
|
|
|
|
The Steering Committee of the ISSUE 3 Study
International study on syncope of uncertain aetiology 3 (ISSUE 3): pacemaker therapy for patients with asystolic neurally-mediated syncope: rationale and study design
Europace,
January 1, 2007;
9(1):
25 - 30.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
