A patient treated with tilt training and midodrine after 68 seconds asystole during head-up tilt table testing.

Neurocardiogenic syncope is a relatively common cause of syncope and is diagnosed by head-up tilt testing. A 21-year-old man was examined for frequent syncope episodes which occurred after episodes of blood drawing and standing in queue. Syncope developed in tilt table testing. After about 68 seconds, sinus rhythm returned. Recent reports have shown that tilt training is a very effective therapy for recurrent neurocardiogenic syncope. In our case, the patient was treated with midodrine 2.5 mg once a day and a tilt training programme. Therapy resulted in improvement and during a follow-up of six months, no major events occurred.