Management of vasovagal syncope: Controlling or aborting faints by leg crossing and muscle tensing

Background - Posture-related vasovagal syncope is by far the most frequent cause of transient loss of consciousness, and present pharmacological and cardiac pacing treatment remains unsatisfactory. A simple maneuver to prevent or diminish vasovagal reactions would be beneficial. Methods and Results - Twenty-one patients with recurrent syncope (age 17 to 74 years, 11 males) who were referred for routine tilt-table testing and had a positive test were included. They were instructed to perform leg crossing and muscle tensing for at least 30 seconds at the onset of a tilt table-provoked impending faint. Continuously measured blood pressure and heart rate at nadir and during the maneuver were compared. Ten months after the test, a telephone follow-up was performed. The physical counter- maneuver, performed in 20 of 21 subjects, increased blood pressure and heart rate. Systolic blood pressure rose from 65±13 to 106± mm Hg (mean±SD, P<0.001), and diastolic blood pressure rose from 43±9 to 65±10 mm Hg (P<0.001). During the maneuver, prodromal symptoms disappeared in all patients, and none lost consciousness. After terminating the maneuver, symptoms did not return in 5 subjects during the test. At follow-up, 13 of 20 patients reported that they applied the maneuver in daily life and benefited from it. Conclusions - Leg crossing combined with tensing muscles at the onset of prodromal symptoms can postpone and in some subjects prevent vasovagal syncope.