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Effects of Orthostatic Self‐Training on Head‐Up Tilt Testing and Autonomic Balance in Patients with Neurocardiogenic Syncope

Summary: To investigate the effectiveness and the mechanisms of an orthostatic self‐training program for the prevention of neurocar‐diogenic syncope, 28 patients were treated with an orthostatic selftraining program. Syncope was induced by head‐up tilt testing (+ 80° for 30 min) in all patients. The onset time of the tilt‐induced syncope was 14 ± 7 min following placement in the upright position. The orthostatic self‐training program included standing against a wall without moving twice a day every day for a planned duration of up to 30 min at home. The head‐up tilt response was reevaluated after 24 ± 6 days based on results of the self‐training. In 12 of the 28 patients, the sympathovagal balance was also determined during the head‐up tilt test before and after the training with power spectral analysis of heart rate variability using a maximal entropy method. Syncope was not observed in any patient after the training. Although the low frequency/high frequency ratio in the supine position was not different before and after the training, the ratio after 3 min in the upright position after the training decreased significantly compared with that before the training. High‐frequency components in the supine and upright positions were not different before and after the training. We concluded that orthostatic self‐training significantly improved symptoms in patients with tilt‐induced neurocardiogenic syncope. Decreased sympathetic activity in the early stage of the upright position period may play an important role in the mechanisms of this therapy.