Prospective evaluation of non-pharmacological treatment in vasovagal syncope

Abstract

AimsInitial treatment of vasovagal syncope (VVS) consists of assuring an adequate fluid and salt intake, regular exercise and application of physical counterpressure manoeuvres. We examined the effects of this non-pharmacological treatment in patients with frequent recurrences. Methods and resultsOne hundred patients with 3 episodes of VVS in the 2 years prior to the start of the study openly received nonpharmacological treatment. We evaluated this treatment both with respect to syncopal recurrences, factors associated with recurrence, and quality of life (QoL). The median number of syncopal recurrences was lower in the first year of non-pharmacological treatment compared with the last year before treatment (median 0 vs. 3; P , 0.001), but 49% of patients experienced at least one recurrence. In multivariable analysis, a higher syncope burden prior to inclusion was significantly associated with syncopal recurrence. Disease-specific QoL improved over time, with larger improvements for patients with more reduction in syncope burden. ConclusionIn patients with frequent recurrences of VVS, non-pharmacological treatment has a beneficial effect on both syncopal recurrence and QoL, but nearly half of these patients still experience episodes of syncope.--

Does any therapy really work for neurocardiogenic syncope?

“…In 100 patients with NCS, the median number of syncopal recurrences was significantly lower in the first year after vs. before non-pharmacological treatment (median 0 vs. 3; p < 0.001) [14]. A placebo effect, regression to the mean, and spontaneous improvement undoubtedly contribute.…”

“…However, syncope recurrence decreases over time in cohorts without additional intervention (syncope is self-limited for the majority) [13,14]. In 100 patients with NCS, the median number of syncopal recurrences was significantly lower in the first year after vs. before non-pharmacological treatment (median 0 vs. 3; p < 0.001) [14].…”

“…However, although syncope burden and QOL exhibit a dose-response relationship, the correlation coefficient is weak and most apparent in more severe cases [14,23,26]. Given the complex pathophysiology and precipitants, complete eradication of symptoms is unlikely in many patients.…”

“…Generic instruments permit comparisons across populations and economic analysis (e.g. SF-36) [14,39]. Disease-specific measures assess the impact on daily living and facilitate comparisons between studies in patients with the same disease (e.g.…”

Expanding the Evidence Base in the Pharmacological Management of Vasovagal Syncope – the Next Post

“…A combination of explanation of the mechanism, reassurance, information on avoiding provocative circumstances, good oral fluid intake and actions to take at the onset of prodromal symptoms to minimise the frequency and severity of symptoms are advocated. 4 Physical counterpressure manoeuvres have been demonstrated to significantly reduce syncope recurrence rates. 5 Despite these measures, a proportion of patients continue to experience disabling symptoms and recurrent syncope.…”