Advances in Treating Vasovagal Neurocardiogenic Syndrome: A Comprehensive Review of Medical Interventions

Abstract

Neurocardiogenic vasovagal syndrome (VVS) is a common clinical condition that results in a transient loss of consciousness and inability to maintain posture, with a rapid and spontaneous recovery. Considering the technological advances regarding the effectiveness of different treatments for VVS, this article aims to review the treatment options available in the medical literature to better understand the treatment options and their potential benefits. This study is a literature review of the medical literature focused on publications from 2005 to 2022 related to the therapeutic management of VVS. Digital databases such as PubMed and SciELO were searched using the descriptors “vasovagal syncope”, “neurocardiogenic syncope” and “treatment of vasovagal syncope” to identify relevant studies. Orthostatic training (or tilt training) is a non-pharmacological approach that involves postural training performed through multiple sessions of orthostasis. Tilt training (TTr) proved to be an effective therapeutic method with long-term benefits in refractory patients. Pharmacological treatment should be considered in a case-by-case scenario. Cardioneuroablation is a procedure that has been shown to eliminate or significantly reduce the vagal response, leading to symptom relief in up to 75% of patients. Results showed that implementing a definitive pacemaker reduced symptoms in at least one-third of patients. In summary, treatment strategies for VVS are evolving with advances in medical research, allowing for a thorough analysis of each modality to determine its suitability. It is crucial to emphasize that the selection of treatment options should be evaluated by a specialist individually to ensure effective management of the patient’s clinical manifestations. Thus, available interventions have the potential to improve patient’s quality of life significantly.