Physical counter-pressure manoeuvres in preventing syncopal recurrence in patients older than 40 years with recurrent neurally mediated syncope: a controlled study from the Third International Study on Syncope of Uncertain Etiology (ISSUE-3)†
Abstract
AIMS: Physical counter-pressure manoeuvres (PCM) are effective in young patients with vasovagal syncope and recognizable prodromal symptoms. The aim of this study was to investigate their effectiveness in patients ≥40 years with severe neurally mediated syncope (NMS) enroled in the Third International Study on Syncope of Uncertain Etiology (ISSUE-3). METHODS AND RESULTS: In the ISSUE-3 study, 63 out of 162 patients had a diagnosis of hypotensive NMS (Types 2, 3, and 4A) documented by implantable loop recorder; of these, 40 were instructed to perform isometric leg and arm PCM therapy. Their mean age was 62 ± 13 years; 47% of patients had a history of some episodes without prodrome. A group of 45 untreated patients acted as controls. The primary endpoint was the time to first syncope recurrence. During follow-up, syncope recurred in 15 PCM patients (37%) and in 24 control patients (53%) (P = 0.14). At 21 months, the modelled syncope recurrence rates were 42% [95% confidence interval (CI): 27-61] and 64% (95% CI: 48-80), respectively (P = 0.27). CONCLUSION: In conclusion, many ISSUE-3 patients affected by hypotensive NMS have syncopal recurrence despite PCM. Older age and the absence of sufficiently long recognizable prodromal symptoms in the ISSUE-3 population might have hampered the effectiveness of PC therapy.
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Physical counter-pressure manoeuvres cannot be used in patients with short or absent prodrome.
“A limitation of this treatment is that it cannot be used in patients with short or absent prodrome”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [264]
Physical counter-pressure manoeuvres are less effective in patients older than 60 years.
“and that PCM are less effective in patients older than 60 years. 264”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [264]
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2018 ESC Guidelines for the diagnosis and management of syncope
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Self-citation
- Authors
- Tomaino, M., Romeo, C., Vitale, E., Kus, T., Moya, A., van Dijk, N., Giuli, S., D'Ippolito, G., Gentili, A., Sutton, R., & on behalf of the International Study on Syncope of Uncertain Etiology 3 (ISSUE-3) Investigators
- Affiliations
- Ospedale di Bolzano (IT)
- Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo (IT)
- Department of Cardiology, Hospital du Sacre-Coeur de Montreal, 5400 Montreal, Canada
- Department of Cardiology, Hospital Universitario Vall d'Hebron, 08035 Barcelona, Spain
- Department of Cardiology, Academisch Medisch Centrum, 1105 Amsterdam, The Netherlands
- Medtronic (Italy) (IT)
- Imperial College Healthcare NHS Trust (GB)
- Corresponding author
- Tomaino, Marco
- Venue
- EP Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-06-06
- Volume
- 16
- Issue
- 10
- Pages
- 1515-1520
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2110530974
- Cited by
- 32
- References
- 24
- Citations by year
- 2025: 2 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 3 · 2020: 3 · 2019: 6 · 2018: 3 · 2017: 1 · 2016: 3 · 2015: 2
- FWCI
- 1.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Keywords
- neurally mediated syncope, syncope recurrence, older adults, prodromal symptoms, implantable loop recorder
- MeSH terms
- Aged, Arm, Female, Humans, Leg, Male, Middle Aged, Motor Activity, Recurrence, Case-Control Studies, Treatment Outcome, Syncope, Vasovagal
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