Tilt training can effectively prevent and reduce the fear of fainting, according to a new study presented at EHRA 2019, a European Society of Cardiology (ESC) congress.
The programme also improved quality of life, reduced the worry and fear about future fainting and enabled patients to return to work.
"Our study included teachers who fainted in the classroom and had to quit work," said study author Dr. Sergio Laranjo, of the Hospital Santa Marta, Lisbon, Portugal. "None of the conventional treatments had helped, but after tilt training, they stopped fainting and were able to resume their jobs."
A tilt training programme was designed to retrain the autonomic nervous system (which controls heart rate and blood pressure) to respond correctly to moving to an upright position.
The response of both the autonomic nervous system and cardiovascular system improved - for example, blood pressure did not drop when moving upright and cardiac output (the volume of blood pumped with each beat) normalized. But, more importantly, an average of 5.5 years after the programme, 86 percent of patients had not fainted again. In the rest (14%), average numbers of yearly faints (syncope) and presyncopal episodes (feeling faint) fell significantly by more than half - from five faints to less than two, and from more than 11 presyncopal episodes to less than five.
Twenty-five patients completed the "Impact of Syncope on Quality of Life" questionnaire before tilt training and six months afterward. It showed that tilt training was significantly associated with less worry, fear, and frustration related to fainting.
"Patients were able to lead full, normal lives after the tilt training programme," said Dr. Laranjo. "Most participants were of working age - the average age was 46 - and could return to work."
The study enrolled 102 patients who had fainted at least twice in the previous six months or fainted once and had three presyncopal episodes in the previous year.
The protocol had two parts. In the hospital part, patients lay down on a table that moved up to 60o for six sessions and 70o for three sessions - each time staying raised for 20-30 minutes while electrocardiogram (ECG) and blood pressure measurements were taken. The nine sessions were spread across three weeks, there was a month break, and the nine sessions were repeated across three weeks. The home-based part consisted of sitting up in bed at 60-70o for 30 minutes daily, sleeping with extra pillows so the head was at 10o, avoiding quick upright movements, drinking around 2.5 liters of water daily, and doing aerobic exercise for 30 minutes a day.
Aerobic exercise was included to retrain the muscles and cardiovascular system, noted Dr. Laranjo. "Despite their young age, the fear of fainting caused these patients to become very inactive," he said.
Dr. Laranjo said that many patients with syncope are passed between doctors in different specialties with no effective treatment. "These results show that tilt training is a safe and effective treatment option for selected patients with recurrent syncopal episodes," he said.
ESC guidelines recommend that patients are referred to a syncope unit for one-stop multidisciplinary assessment, diagnosis, therapy, and follow-up.