Recurrent supine syncope: An unusual manifestation of the neurally mediated faint

Demosthenes Iskos, Jeffrey J. Shultz, David G Benditt

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6 Scopus citations


Introduction: Syncope occasionally may occur in the supine patient due to severe brady- or tachyarrhythmia. However, recurrent syncope upon assumption of the supine position as a result of a neurally mediated reflex mechanism has not been reported previously. Methods and Results: Two young patients, both of whom had significant systemic illnesses, experienced recurrent episodes of presyncope and/or syncope shortly after assuming the supine position. During ambulatory ECG monitoring, symptoms were provoked only by lying down and were associated with transient bradycardia. Head-up tilt table testing was undertaken as part of the syncope evaluation and was nondiagnostic in both cases. However, both patients exhibited a transient cardioinhibitory response with reproduction of typical symptoms upon return of the table to the supine position ('reverse tilt'). During follow-up (8 and 14 months), both patients improved with pharmacologic treatment (disopyramide in one case and midodrine in the other). Conclusion: Presyncope or syncope upon lying down can be an unusual manifestation of the neurally mediated faint.

Original languageEnglish (US)
Pages (from-to)441-444
Number of pages4
JournalJournal of cardiovascular electrophysiology
Issue number4
StatePublished - 1998


  • Neurally mediated faint
  • Neurocardiogenic
  • Syncope
  • Tilt table study
  • Vasovagal syncope


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