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Therapy: Conclusive Remarks

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Vasovagal Syncope

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Abstract

The course of vasovagal syncope (VVS) is benign, but when it is recurrent, it may be highly symptomatic, leading to significant deterioration of quality of life with psychological, driving, and employment implications [1]. Therefore, every treatment can be addressed only to improve quality of life and not to prolong survival. Patients seeking medical assistance after experiencing an episode of VVS often undergo costly diagnostic examinations and are anxious and concerned about the possibility to be at increased risk of dying or suffering from a myocardial infarction or stroke. Therefore, priority should be given to patient’s reassurance about the benign nature of VVS. There are no evidence-based data on the effects of such a reassurance, but clinical experience suggests that a convincing advice often improves the quality of life of patients with recurrent VVS. Conventional therapy of VVS includes lifestyle modification, pharmacological treatment, and cardiac pacing.

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References

  1. Moya A, Sutton R, Ammirati F et al (2009) Guidelines for diagnosis and management of syncope (version 2009). The Task force for the diagnosis and management of syncope of the European Society of Cardiology (ESC). Developed in collaboration with European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS). Eur Heart J 30:2631–2671

    Article  PubMed Central  PubMed  Google Scholar 

  2. Sheldon R, Connolly S, Rose S et al (2006) Prevention of syncope trial (POST). A randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope. Circulation 113:1164–1170

    Article  PubMed  Google Scholar 

  3. Raviele A, Brignole M, Sutton R et al (1999) Effect of etilefrine in preventing syncopal recurrence in patients with vasovagal syncope: a double-blind, randomized, placebo-controlled trial The Vasovagal Syncope International Study. Circulation 99:1452–1457

    Article  CAS  PubMed  Google Scholar 

  4. Ward CR, Gray JC, Gilroy JJ et al (1998) Midodrine: a role in the management of neurocardiogenic syncope. Heart 79:45–49

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Perez-Lugones A, Schweikert R, Pavia S et al (2001) Usefulness of midodrine in patients with severely symptomatic neurocardiogenic syncope: a randomized control study. J Cardiovasc Electrophysiol 12:935–938

    Article  CAS  PubMed  Google Scholar 

  6. Kaufmann H, Saadia D, Voustianiouk A et al (2002) Midodrine in neurally mediated syncope: a double-blind, randomized, crossover study. Ann Neurol 52:542–545

    Article  Google Scholar 

  7. Zhang QY, Du JB, Tang CS (2006) The efficacy of midodrine hydrochloride in the treatment of children with vasovagal syncope. J Pediatr 149:777–780

    Article  CAS  Google Scholar 

  8. Liao Y, Li X, Zhang Y et al (2009) α-Adrenoceptor agonists for the treatment of vasovagal syncope: a meta-analysis of worldwide published data. Acta Paediatr 98:1194–2000

    Article  CAS  PubMed  Google Scholar 

  9. Romme JJ, van Dijk N, Go-Schon IK et al (2011) Effectiveness of midodrine treatment in patients with recurrent vasovagal syncope not responding to non-pharmacological treatment (STAND-trial). Europace 13:1639–1647

    Article  PubMed  Google Scholar 

  10. Raj SR, Faris PD, McRae M et al (2012) Rationale for the prevention of syncope trial IV: assessment of midodrine. Clin Auton Res 22:275–280

    Article  PubMed Central  PubMed  Google Scholar 

  11. Salim MA, Di Sessa TG (2005) Effectiveness of fludrocortisone and salt in preventing syncope recurrence in children: a double, placebo-controlled, randomized trial. J Am Coll Cardiol 45:484–488

    Article  CAS  PubMed  Google Scholar 

  12. Sheldon R, Morillo CA, Krahn A et al (2011) A randomized clinical trial of fludrocortisone for the prevention of vasovagal syncope (POST2). Can J Cardiol 27:S335–S336

    Article  Google Scholar 

  13. Di Gerolamo E, Di Iorio C, Sabatini O et al (1999) Effects of paroxetine hydrochloride, a selective serotonin reuptake inhibitor, on refractory vasovagal syncope: a randomized, double-blind, placebo-controlled study. J Am Coll Cardiol 33:1227–1230

    Article  Google Scholar 

  14. Theodorakis GN, Leftheriotis D, Livanis EG et al (2006) Fluoxetine vs propanolol in the treatment of vasovagal syncope: a prospective, randomized, placebo-controlled study. Europace 8:193–198

    Article  PubMed  Google Scholar 

  15. Sutton R, Salukhe TV, Franzen-Mcmanus AC et al (2014) Ivabradine in treatment of sinus tachycardia mediated vasovagal syncope. Europace 16:284–288

    Article  PubMed  Google Scholar 

  16. Alboni P (2010) Therapy of vasovagal syncope: to prevent the vasovagal reflex or to treat the impending reflex. Europace 12:776–778

    Article  PubMed  Google Scholar 

  17. El-Sayed H, Hainsworth R (1995) Relationship between plasma volume, carotid baroceptor sensitivity and orthostatic tolerance. Cli Sci (Colch) 88:463–470

    CAS  Google Scholar 

  18. El-Sayed H, Hainsworth R (1996) Salt supplement increases plasma volume and orthostatic tolerance in patients with unexplained syncope. Heart 75:134–140

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Shichiri M, Tanaka H, Takaya R et al (2002) Efficacy of high sodium intake in a boy with instantaneous orthostatic hypotension. Clin Auton Res 12:47–50

    Article  PubMed  Google Scholar 

  20. Wieling W, van Lieshout JJ, Hainsworth R (2002) Extracellular fluid volume expansion in patients with posturally related syncope. Clin Auton Res 12:242–249

    Article  CAS  PubMed  Google Scholar 

  21. Mtinangi BL, Hainsworth R (1998) Early effects of oral salt on plasma volume, orthostatic tolerance, and baroreceptor sensitivity in patients with syncope. Clin Auton Res 8:231–235

    Article  CAS  PubMed  Google Scholar 

  22. Wieling W, Colman N, Krediet CT et al (2004) Non-pharmacological treatment of reflex syncope. Clin Auton Res 14(Suppl 1):62–70

    Article  PubMed  Google Scholar 

  23. Jordan J, Shannon JR, Black BK et al (2000) The pressor response to water drinking in humans. A sympathetic reflex? Circulation 101:504–509

    Article  CAS  PubMed  Google Scholar 

  24. Cariga P, Mathias CJ (2001) Haemodynamics of the pressor effect of oral water in human sympathetic denervation due to autonomic failure. Clin Sci 101:313–319

    Article  CAS  PubMed  Google Scholar 

  25. Shannon JR, Diedrich A, Biaggioni I et al (2002) Water drinking as a treatment for orthostatic syndromes. Am J Med 112:355–360

    Article  PubMed  Google Scholar 

  26. Schroeder C, Bush V, Norcliffe L et al (2002) Water drinking acutely improves orthostatic tolerance in healthy subjects. Circulation 106:2806–2811

    Article  PubMed  Google Scholar 

  27. Lu CC, Diedrich A, Tung CS et al (2003) Water ingestion as prophylaxis against syncope. Circulation 108:2660–2665

    Article  PubMed  Google Scholar 

  28. Claydon VE, Schroeder C, Norcliffe LJ et al (2006) Water drinking improves orthostatic tolerance in patients with posturally related syncope. Clin Sci 110:343–352

    Article  PubMed  Google Scholar 

  29. Wieling W, van Lieshout JJ (2002) The fainting risk. Clin Auton Res 12:242–249

    Article  CAS  PubMed  Google Scholar 

  30. Gardenghi G, Rondon MUPB, Braga AMFW et al (2007) The effects of exercise training on arterial baroreflex sensitivity in neurally mediated syncope patients. Eur Heart J 28:2749–2755

    Article  PubMed  Google Scholar 

  31. Convertino VA, Montgomery LD, Greenleaf JE (1984) Cardiovascular responses during orthostasis: effect of an increase in VO2max. Aviat Space Environ Med 55:702–708

    CAS  PubMed  Google Scholar 

  32. Greenleaf JE (ed) (2004) Deconditioning and reconditioning. CRC Press, London, pp 150–151

    Google Scholar 

  33. Verheyden B, Ector H, Aubert AE et al (2008) Tilt training increases the vasoconstrictor reserve in patients with neurally mediated syncope evoked by head-up tilt testing. Eur Heart J 29:1523–1530

    Article  PubMed  Google Scholar 

  34. Ector H, Willems R, Heidbüchel H et al (2005) Repeated tilt testing in patients with tilt-positive neurally mediated syncope. Europace 7:628–633

    Article  PubMed  Google Scholar 

  35. Foglia-Manzillo G, Giada G, Gaggioli G et al (2004) Efficacy of tilt-training in the treatment of neurally mediated syncope. A randomized study. Europace 6:199–204

    Article  PubMed  Google Scholar 

  36. On YK, Park J, Huh J et al (2007) Is home orthostatic self-training effective in preventing neurally mediated syncope? Pacing Clin Electrophysiol 30:638–643

    Article  PubMed  Google Scholar 

  37. Zeng H, Ge K, Zhang W et al (2008) The effect of orthostatic training in the prevention of vasovagal syncope and its influencing factors. Int Heart J 49:707–712

    Article  PubMed  Google Scholar 

  38. Tan MP, Newton JL, Chadwick TJ et al (2010) Home orthostatic training in vasovagal syncope modifies autonomic tone: results of a randomized, placebo-controlled pilot study. Europace 12:240–246

    Article  PubMed  Google Scholar 

  39. Dos Santos RQ, Smidt L, Suzigan BH et al (2013) Efficacy of limb compression in the management of vasovagal syncope – randomized, crossover study. Pacing Clin Electrophysiol 36:451–455

    Article  PubMed  Google Scholar 

  40. Cohen TJ, Thayapran N, Ibrahim B et al (2000) An association between anxiety and neurocardiogenic syncope during head up tilt table testing. Pacing Clin Electrophysiol 23:837–841

    Article  CAS  PubMed  Google Scholar 

  41. Giada F, Silvestri I, Rossillo A et al (2005) Psychiatric profile, quality of life and risk of syncopal recurrence in patients with tilt-induced vasovagal syncope. Europace 7:465–471

    Article  PubMed  Google Scholar 

  42. Gracie J, Newton JL, Norton M et al (2006) The role of psychological factors in response to treatment in neurocardiogenic (vasovagal) syncope. Europace 8:636–643

    Article  PubMed  Google Scholar 

  43. Flint B, Baker C, Freeston M et al (2009) Level of psychological impairment predicts early response to treatment in vasovagal syncope. Europace 11:231–236

    Article  PubMed  Google Scholar 

  44. Romme JJ, van Dijk N, Go-Schon IK et al (2011) Association between psychological complaints and recurrence of vasovagal syncope. Clin Auton Res 21:373–380

    Article  PubMed  Google Scholar 

  45. Newton JL, Kenny RA, Baker CB (2003) Cognitive behavioural therapy for treatment of resistant vasovagal/neurocardiogenic syncope. Europace 5:299–301

    Article  CAS  PubMed  Google Scholar 

  46. Ditto B, Byrne N, Holly C (2009) Physiological correlates of applied tension may contribute to reduced fainting during medical procedures. Ann Behav Med 37:306–314

    Article  PubMed  Google Scholar 

  47. Ducasse D, Capdevielle D, Attal J et al (2013) Blood-injection-injury-phobia: psychophysiological and therapeutical specifities. Encéphale 39:326–331

    Article  CAS  PubMed  Google Scholar 

  48. Leftheriotis D, Michopoulos I, Flevari P et al (2008) Minor psychiatric disorders and syncope: the role of psychopathology in the expression of vasovagal reflex. Psychother Psychosom 77:372–376

    Article  PubMed  Google Scholar 

  49. Rosoff MH, Cohen MV (1986) Profound bradycardia after amylnitrite in patients with a tendency to vasovagal episodes. Br Heart J 55:97–100

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  50. Gaggioli G, Bottoni N, Mureddu R et al (1997) Effects of chronic vasodilator therapy to enhance susceptibility to vasovagal syncope during upright tilt testing. Am J Cardiol 80:1092–1094

    Article  CAS  PubMed  Google Scholar 

  51. Brignole M, Croci F, Menozzi C et al (2002) Isometric arm counter-pressure manoeuvres to abort impending vasovagal syncope. J Am Coll Cardiol 40:2053–2059

    Article  PubMed  Google Scholar 

  52. Krediet CT, van Dijk N, Linzer M et al (2002) Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation 106:1684–1689

    Article  PubMed  Google Scholar 

  53. Krediet CT, de Bruin IG, Ganzeboom KS et al (2005) Leg crossing, muscle tensing, squatting, and the crash position are effective against vasovagal reactions solely through increases in cardiac output. J Appl Physiol 99:1697–1703

    Article  PubMed  Google Scholar 

  54. van Dijk N, Quartieri F, Blanc JJ et al (2006) Effectiveness of physical counterpressure manoeuvres in preventing vasovagal syncope: the Physical Counterpressure Manoeuvre Trial (PC-Trial). J Am Coll Cardiol 48:1652–1657

    Article  PubMed  Google Scholar 

  55. Connolly SJ, Sheldon R, Roberts RS et al (1999) Vasovagal pacemaker study investigators. The North American vasovagal pacemaker study (VPS): a randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. J Am Coll Cardiol 33:16–20

    Article  CAS  PubMed  Google Scholar 

  56. Sutton R, Brignole M, Menozzi C et al (2000) Dual-chamber pacing in treatment of neurally-mediated tilt-positive cardioinhibitory syncope. Pacemaker versus no therapy: a multicenter randomized study. Circulation 102:294–299

    Article  CAS  PubMed  Google Scholar 

  57. Ammirati F, Colivicchi F, Santini M (2001) Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope. A multicenter, randomized, controlled trial. Circulation 104:52–57

    Article  CAS  PubMed  Google Scholar 

  58. Connolly SJ, Sheldon R, Thorpe KE et al (2003) Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope: second vasovagal pacemaker study (VPS II). JAMA 289:2224–2229

    Article  PubMed  Google Scholar 

  59. Raviele A, Giada F, Menozzi C et al (2004) The vasovagal syncope and pacing trial (Synpace). A randomized placebo-controlled study of permanent pacing for treatment of recurrent vasovagal syncope. Eur Heart J 25:1741–1748

    Article  PubMed  Google Scholar 

  60. Sud S, Massel D, Klein GJ et al (2007) The expectation effect and cardiac pacing for refractory vasovagal syncope. Am J Med 120:54–62

    Article  PubMed  Google Scholar 

  61. Brignole M, Menozzi C, Moya A et al (2012) Pacemaker therapy in patients with neutrally mediated syncope and documented asystole. Third International Study on Syncope of Uncertain Etiology (ISSUE-3). A randomized trial. Circulation 125:2566–2571

    Article  PubMed  Google Scholar 

  62. Sutton R, Ungar A, Sgobino P et al (2014) Cardiac pacing in patients with neurally mediated syncope and documented asystole: effectiveness analysis from third international study on syncope of uncertain etiology (ISSUE-3) registry. Europace 16:595–599

    Article  PubMed  Google Scholar 

  63. Brignole M, Donateo P, Tomaino M et al (2014) The benefit of pacemaker therapy in patients with presumed neurally-mediated syncope and documented asystole is greater when tilt test is negative. An analysis from the third international study on syncope of uncertain etiology (ISSUE-3). Circ Arrhythm Electrophysiol 7:10–16

    Article  PubMed  Google Scholar 

  64. Alboni P (1997) The cardiologist’s “oculobradycardial” reflex: a potential risk of overtreatment by utilizing the event recorder in the diagnosis of unexplained syncope. G Ital Cardiol 27:1334–1336

    CAS  PubMed  Google Scholar 

  65. Maggi R, Rafanelli M, Ceccofiglio A et al (2014) Additional diagnostic value of implantable loop recorder in patients with initial diagnosis of real or apparent transient loss of consciousness of uncertain origin. Europace 16:1226–1230

    Article  Google Scholar 

  66. Pachon JC, Pachon EI, Pachon JC et al (2005) “Cardioneuroablation” – new treatment for neurocardiogenic syncope, functional AV block and sinus dysfunction using catheter RF ablation. Europace 7:1–13

    Article  PubMed  Google Scholar 

  67. Scanavacca M, Hachul D, Pisani C et al (2009) Selective vagal denervation of the sinus and atrioventricular nodes, guided by vagal reflexes induced by high frequency stimulation, to treat refractory neurally mediated syncope. J Cardiovasc Electrophysiol 20:558–563

    Article  PubMed  Google Scholar 

  68. Pachon JC, Pachon EI, Pachon MZC et al (2011) Catheter ablation of severe neurally mediated reflex (neurocardiogenic or vasovagal) syncope: cardioneuroablation long-term results. Europace 13:1231–1242

    Article  PubMed  Google Scholar 

  69. Yao Y, Shi R, Wong T et al (2012) Endocardial autonomic denervation of the left atrium to treat vasovagal syncope. An early experience in humans. Circ Arrhythm Electrophysiol 5:279–286

    Article  PubMed  Google Scholar 

  70. Aydin MA, Mortensen K, Salukhe TV et al (2012) A standardized education protocol significantly reduces traumatic injuries and syncope recurrence: an observational study in 316 patients with vasovagal syncope. Europace 14:410–415

    Article  PubMed  Google Scholar 

  71. Alboni P, Dinelli M, Gianfranchi L et al (2007) Current treatment of recurrent vasovagal syncope: between evidenced-based therapy and common sense. J Cardiovasc Med 8:835–839

    Article  Google Scholar 

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Authors and Affiliations

  1. Section of Cardiology and Syncope Unit, Ospedale Privato Quisisana, Ferrara, Italy

    Paolo Alboni

  2. Internal Medicine, Humanitas Clinical and Research Center, University of Milan, Rozzano, Milan, Italy

    Raffaello Furlan

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  1. Paolo Alboni
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  2. Raffaello Furlan
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Correspondence to Paolo Alboni .

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Editors and Affiliations

  1. Section of Cardiology, Ospedale Privato Quisisana, Ferrara, Italy

    Paolo Alboni

  2. Department of Medicine - BIOMETRA, Humanitas Research Hospital, Rozzano, Milan, Italy

    Raffaello Furlan

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Alboni, P., Furlan, R. (2015). Therapy: Conclusive Remarks. In: Alboni, P., Furlan, R. (eds) Vasovagal Syncope. Springer, Cham. https://doi.org/10.1007/978-3-319-09102-0_21

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