Efficacy and feasibility of isometric arm counter-pressure manoeuvres to abort impending vasovagal syncope during real life

AIMS: Isometric arm exercises are able to increase blood pressure during the phase of impending vasovagal syncope. We evaluated their efficacy and feasibility during daily life in a group of 29 consecutive patients affected by vasovagal syncopes. METHODS: The patients were trained to use arm tensing and/or handgrip in case of occurrence of symptoms of impending syncope. RESULTS: During 14+/-6 months of follow-up, 260 episodes of impending syncope were reported by 19 patients; the manoeuvres were self-administered by these patients in 98% of cases and were able to abort syncope in 99.6% of cases. Overall, 5 episodes of syncope occurred in 5 patients (17%), in 4 cases without and in 1 with activation of the manoeuvres. Syncope recurred in 4 (40%) of 10 patients aged >65 years versus only 1 (5%) of 19 patients aged < or =65 years, p=0.03. The non-responders had more episodes of impending syncope than responders (37+/-32 vs 3+/-4, p=0.001). Among 19 clinical variables, age in years was the only significant predictor of syncopal recurrence. No patients had injury or other adverse morbidity related to the relapses. CONCLUSIONS: Isometric arm counter-pressure manoeuvres are able to abort impending vasovagal syncope in most patients aged < or =65 years. Arm counter-pressure manoeuvres are feasible, safe and well accepted by the patients in the daily life.