Effectiveness of physical counterpressure maneuvers in preventing vasovagal syncope: the Physical Counterpressure Manoeuvres Trial (PC-Trial).

Full Abstract

OBJECTIVES:
In this study, we assessed the effectiveness of physical counterpressure maneuvers (PCM) in daily life.

BACKGROUND:
There is presently no evidence-based therapy for vasovagal syncope. Current treatment consists of explanation and life-style advice. Physical counterpressure maneuvers have been shown to raise blood pressure and to control or abort vasovagal episodes in laboratory conditions.

METHODS:
We performed a multicenter, prospective, randomized clinical trial, which included 223 patients age 38.6 (+/-15.4) years with recurrent vasovagal syncope and recognizable prodromal symptoms. One hundred and seventeen patients were randomized to standardized conventional therapy alone, and 106 patients received conventional therapy plus training in PCM.

RESULTS:
The median yearly syncope burden during follow-up was significantly lower in the group trained in PCM than in the control group (p = 0.004). During a mean follow-up period of 14 months, overall 50.9% of the patients with conventional treatment and 31.6% of the patients trained in PCM experienced a syncopal recurrence (p = 0.005). Actuarial recurrence-free survival was better in the treatment group (log-rank p = 0.018), resulting in a relative risk reduction of 39% (95% confidence interval, 11% to 53%). No adverse events were reported.

CONCLUSIONS:
Physical counterpressure maneuvers are a risk-free, effective, and low-cost treatment method in patients with vasovagal syncope and recognizable prodromal symptoms, and should be advised as first-line treatment in patients presenting with vasovagal syncope with prodromal symptoms. (The PC-Trial; http://www.controlled-trials.com/isrctn/trial/45146526/0/45146526.html; ISRCTN45146526).

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Author information

Author/s: van Dijk, Nynke (N); Quartieri, Fabio (F); Blanc, Jean-Jaques (JJ); Garcia-Civera, Roberto (R); Brignole, Michele (M); Moya, Angel (A); Wieling, Wouter (W); PC-Trial Investigators;

Affiliation: Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands. n.vandijk(-atsign-)amc.uva.nl

Journal and publication information

Publication Type: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

Journal: Journal of the American College of Cardiology (J Am Coll Cardiol), published in United States. (Language: eng)

Reference: 2006-Oct; vol 48 (issue 8) : pp 1652-7

Dates: Created 2006/10/18; Completed 2006/11/21; Revised 2007/11/15;

PMID: 17045903, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: ACP J Club. 2007 Mar-Apr;146(2):41. (PMID: 17335164)

CommentIn: Evid Based Med. 2007 Apr;12(2):44. (PMID: 17400636)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Actuarial Analysis
Adolescent
Adult
Aged
Arm - physiology
Hand - physiology
Hemodynamics
Humans

Humans
Leg - physiology
Middle Aged
Motor Activity - physiology
Pressure
Survival Analysis
Syncope, Vasovagal - prevention & control
Treatment Outcome

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