Simple physical movements reduce vasovagal syncope episodes: PC-Trial

Physical counterpressure maneuvers reduced the number of episodes of vasovagal syncope and reduced the prodrome in a small study conducted in The Netherlands. This should be “first-line therapy in every patient presenting with vasovagal syncope,” stated Nynke van Dijk, Academic Medical Center-University of Amsterdam.
The Netherlands, in concluding her presentation of the Physical Counterpressure Maneuver Trial (PC-Trial) at the American College of Cardiology meeting. The trial was presented in a new session at the ACC meeting, focusing on smaller, hypothesis-generating clinical trials.

Patients with a history of repeated fainting preceded by a known prodrome were randomly assigned to conventional therapy (education and lifestyle modification; n=117) or conventional therapy plus physical counterpressure (PC; n=106) training in 3 techniques (leg crossing, handgrip exercises, arm-tensing exercises). The mean age was 38 years and 28% were male. The number of lifetime syncopal events was similar in both groups (6); syncopal episodes in the previous 2 years (3); presyncopal events in prior year (4); and period of complaints (7-8 years).

At 14 months, the risk of fainting was reduced with PC (0 vs 0.6 conventional therapy; p<0.01). Syncope recurrence was lower with PC (32% vs 51% conventional therapy; p< 0.01). The number of patients experiencing presyncope prodrome was similar in both groups (82% vs 74%; p=0.12). The time to first recurrence was reduced by 40% with PC patients compared to conventional therapy (p=0.018).