Isometric arm counter-pressure maneuvers to abort impending vasovagal syncope

J Am Coll Cardiol. 2002 Dec 4;40(11):2053-9. doi: 10.1016/s0735-1097(02)02683-9.


Objectives: We hypothesized that isometric arm exercises were able to increase blood pressure (BP) during the phase of impending vasovagal syncope and allow the patient to avoid losing consciousness.

Background: Hypotension is always present during the prodromal phase of vasovagal syncope.

Methods: We evaluated the effect of handgrip (HG) and arm-tensing in 19 patients affected by tilt-induced vasovagal syncope. The study consisted of an acute single-blind, placebo-controlled, randomized, cross-over tilt-table efficacy study and a clinical follow-up feasibility study.

Results: In the acute tilt study, HG was administered for 2 min, starting at the time of onset of symptoms of impending syncope. In the active arm, HG caused an increase in systolic blood pressure (SBP) from 92 +/- 10 mm Hg to 105 +/- 38 mm Hg, whereas in the placebo arm SBP decreased from 91 +/- 11 mm Hg to 73 +/- 21 mm Hg (p = 0.008). Heart rate behavior was similar in the two arms. In the active arm, 63% of patients became asymptomatic, versus 11% in the control arm (p = 0.02); conversely, only 5% of patients developed syncope, versus 47% in the control arm (p = 0.01). The patients were trained to self-administer arm-tensing treatment as soon as symptoms of impending syncope occurred. During 9 +/- 3 months of follow-up, the treatment was actually performed in 95/97 episodes of impending syncope (98%) and was successful in 94/95 (99%). No patients suffered injury or other adverse morbidity related to the relapses.

Conclusions: Isometric arm contraction is able to abort impending vasovagal syncope by increasing systemic BP. Arm counter-pressure maneuvers can be proposed as a new, feasible, safe, and well accepted first-line treatment for vasovagal syncope.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Arm / blood supply*
  • Arm / physiology*
  • Blood Pressure / physiology*
  • Diastole / physiology
  • Electric Impedance
  • Electrophysiologic Techniques, Cardiac
  • Exercise Test
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Hand Strength / physiology
  • Heart Rate / physiology
  • Humans
  • Isometric Contraction / physiology*
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Reproducibility of Results
  • Syncope, Vasovagal / physiopathology*
  • Systole / physiology
  • Tilt-Table Test