Prospective evaluation of non-pharmacological treatment in vasovagal syncope

EP Europace, Apr 2010

Initial 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.

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Prospective evaluation of non-pharmacological treatment in vasovagal syncope

Europace Prospective evaluation of non-pharmacological treatment in vasovagal syncope Jacobus J.C.M. Romme 2 Johannes B. Reitsma 2 Ingeborg K. Go-Scho¨ n 0 1 Mark P.M. Harms 6 Jaap H. Ruiter 5 Jan S.K. Luitse 4 Jacques W.M. Lenders 3 7 Wouter Wieling 1 Nynke van Dijk 2 0 BMEYE Cardiovascular Monitoring B.V., Academic Medical Center , Amsterdam , The Netherlands 1 Department of Internal Medicine, Academic Medical Center , Amsterdam , The Netherlands 2 Department of Clinical Epidemiology , Biostatistics and Bioinformatics , Academic Medical Center, University of Amsterdam , J1b-214, Meibergdreef 9, 1105 AZ Amsterdam , The Netherlands 3 Department of Internal Medicine, Radboud University Nijmegen Medical Center , Nijmegen , The Netherlands 4 Department of Surgery, Academic Medical Center , Amsterdam , The Netherlands 5 Department of Cardiology, Medical Center Alkmaar , Alkmaar , The Netherlands 6 Department of Internal Medicine, University Medical Center Groningen , Groningen , The Netherlands 7 Department of Internal Medicine III, University Hospital Carl Gustav Carus Dresden , Dresden , Germany Aims Initial 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 One hundred patients with 3 episodes of VVS in the 2 years prior to the start of the study openly received nonand results pharmacological 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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusion In 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Introduction Syncope is a self-limited episode of transient loss of consciousness (T-LOC) due to a transient hypoperfusion of the brain.1 Reflex syncope is caused by systemic arterial hypotension resulting from reflex vasodilation, bradycardia, or both.2 Vasovagal syncope (VVS), mediated by emotional or orthostatic stress, is the most common cause of reflex syncope.2 – 5 Non-pharmacological treatment, consisting of life style advice and physical counterpressure manoeuvres (i.e. muscle tensing), is recommended as the first line of treatment for VVS in current syncope management guidelines.2 Patients are educated about the benign nature of the condition and are encouraged to increase the dietary salt and fluid intake (blood volume expansion) and to perform moderate exercise training.6,7 In a relatively mildly affected population the combination of lifestyle measures and physical counterpressure manoeuvres have been shown to decrease the syncope burden by 39%.8 However, it is yet unknown whether this combined non-pharmacological treatment is also effective in more severely affected patients. Treatment of VVS should not only be directed at reducing the number of (pre-)syncopal recurrences, but should also aim to improve quality of life (QoL). QoL was found to be lower in patients with T-LOC compared with healthy subjects.9 – 13 Linzer et al.11 reported a level of impairment similar to severe rheumatoid arthritis and chronic low back pain. QoL in patients with T-LOC was found to be influenced by age, gender, co-morbidity, time of onset and frequency of syncopa (...truncated)


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Romme, Jacobus J.C.M., Reitsma, Johannes B., Go-Schön, Ingeborg K., Harms, Mark P.M., Ruiter, Jaap H., Luitse, Jan S.K., Lenders, Jacques W.M., Wieling, Wouter, van Dijk, Nynke. Prospective evaluation of non-pharmacological treatment in vasovagal syncope, EP Europace, 2010, pp. 567-573, Volume 12, Issue 4, DOI: 10.1093/europace/eup414