Tilt training:: A new treatment for recurrent neurocardiogenic syncope and severe orthostatic intolerance

Medical treatment of neurocardiogenic syncope is insufficient in many cases. We have observed a therapeutic effect of repeated head-up tilt testing. Therefore, we have started a program of tilt training for heavily symptomatic patients. After hospital admission, they were tilted daily (60 degrees inclination) until syncope, or until a duration of 45-90 minutes (90 sessions in 13 patients). The mean tilt tolerance, at the first diagnostic head-lip tilt fable test was 22.3 minutes (st, dev. 10.9). Before hospital discharge, 12/13 patients could sustain the full duration of tilt table testing without a?ly symptom. In one patient syncope persisted The patients were instructed to continue a program of daily lilt training at home, by standing against a wall for 30 minutes, one or two limes per day. This resulted in a complete disappearance of syncope in all 13 patients. Orthostatic intolerance and the excessive autonomic reflex activity of neurocardiogenic syncope can be remedied by a program of continued tilt training, without the administration of drugs.