Front. Neurosci.

Sec. Autonomic Neuroscience

Volume 18 - 2024 | doi: 10.3389/fnins.2024.1473687

Provisionally accepted

Miek Hornikx *

Linda Stans

Tomas Robyns

Christophe Garweg

Joris Ector

Bert Vandenberk

Rik Willems²

The final, formatted version of the article will be published soon.

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Purpose-Reflex syncope is a burdensome disease with considerable repercussion on quality of life. Tilt training is a therapeutic option, but evidence on this topic is scarce and outdated. Hyperventilation is oftentimes associated with reflex syncope. The aim of this study was to evaluate the effectiveness of tilt training in patients with reflex syncope and to study the association between reflex syncope and hyperventilation.-Patients referred for tilt training after a positive tilt test from July 2014-March 2021 were included in a single-center, retrospective registry. Demographic characteristics and outcomes of the program were collected. Response of tilt training on (pre)syncope recurrence and the association with hyperventilation was studied. Results-A total of 173 patients were included. The median age was 27 [17-48] years. Patients needed 2 [1-3] sessions to reach a first negative tilt training. The tilt training program was completed successfully by 65% of patients. An additional 3% had no complaints anymore in daily life, despite remaining symptomatic during tilt training. Other therapy was initiated in 10%. Drop-out of the tilt training occurred in 21% of patients. Presyncope recurred in 21% of patients during a follow-up of 21 [16-23] months.Concomitant hyperventilation was suspected in 24%. Among these patients, 74% were referred for a hyperventilation provocation test, which confirmed the diagnosis in 82%.We report a reasonable success of tilt training in a contemporary cohort of patients. In patients completing the tilt training program, presyncope and syncope recurrence was low. Concomitant hyperventilation seems prevalent in patients with reflex syncope and warrants specific attention and treatment.

Keywords: Tilt training, tilt test, Reflex syncope, Presyncope, Hyperventilation

Received: 31 Jul 2024; Accepted: 22 Oct 2024.

Copyright: © 2024 Hornikx, Haemers, Stans, Robyns, Garweg, Ector, Vandenberk and Willems². This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Miek Hornikx, University Hospitals Leuven, Leuven, Belgium

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