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A. Basics
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01. History of Cardiology
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05. Atrial Fibrillation
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07. Syncope and Bradycardia
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30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
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Long-Term results of Tilt Training in Patients with Recurrent Reflex Syncope: focus on quality of life and autonomic modulation
Session:
Painel 4- Arritmologia 3
Speaker:
Sergio Matoso Laranjo
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
07. Syncope and Bradycardia
Subtheme:
07.4 Syncope and Bradycardia - Treatment
Session Type:
Posters
FP Number:
---
Authors:
Sérgio Laranjo; isabel rocha; Mário Martins Oliveira
Abstract
<p>Reflex syncope (rS) is a common clinical entity resulting from an excessive reflex autonomic (ANS) response, particularly during orthostatism. Treatment options are scarce, controversial and of limited effectiveness. Tilt training (TT) has been used in patients (P) with recurrent rS. </p> <p><strong>Aim</strong>: to assess the success rate of TT and characterize hemodynamic and autonomic responses during a TT program in P with repetitive rS.</p> <p><strong>Methods</strong>: Between 2005 and May 2018 we enrolled 102P (57,8% female, 46,1±18,3 years). All had orthostatic induced rS, refractory to conventional measures and documented by head-up tilt (HUT) test. The TT program included 9 sessions, under continuous ECG and blood pressure (BP) monitoring, combined with home orthostatic self-training. Stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR), baroreflex sensitivity (BEI) and heart-rate variability were computed. P were examined at 1 month and every 6 months thereafter. Treatment effects were assessed using a telephone survey. Quality of life (“Impact of Syncope on Quality of Life” questionnaire) was evaluated before beginning the TT program and at 6 months follow-up.</p> <p><strong>Results</strong>: During a follow-up of 66.8±41.3 months after TT, most of the P were free of syncope (n=89; 86,3%) or pre-syncope (n=82, 80%). In the remaining P (14%), there was a significant decrease in the number of syncopes (5.1±2.7/P/year 12 months before vs. 1.4±0.8/P post-TT; p=0.005) and pre-syncope (11,4±6,2/P/year 12 months before TT vs. 4,5±2.6/P post-TT, p=0.017). The TT was associated with a QoL improvement in the ISQL items (related to worry, fear and frustration with the difficulties experienced; ρ <0.05). Over the course of the TT program there was a significant increase in mean systolic BP, SV, TPR and CO. Simultaneously, a shift in ANS response pattern was seen, with an increase of the BEI. P who achieved an increased BEI value were “responders” to the TT programme, showing a significant reduction in symptoms and QoL improvement. A BEI cut off value >57.5 at the first 5 minutes of HUT on the ninth TT session had an AUC of 0.9023 (p<0.0001), with a sensitivity of 89.9% and specificity of 84.6% in predicting response to TT programme.</p> <p><strong>Conclusion</strong>: In refractory rS, TT may be an effective therapeutic option with long-term benefits and a significant impact in QOL. These results are associated with a significant modulation of ANS, with improvement of baroreflex function. </p>
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