title: [Overview on the management of vasovagal syncope].
abstract: BACKGROUND
  Vasovagal syncope (VVS) is the most common type of syncope. Despite its benignity, quality of life may be severely affected in a significant proportion of highly symptomatic patients.
  
  
  OBJECTIVE
  To review achral knowledgement concerning vasovagal syncope, to assess the utility of diagnostic investigation and report the updat therapeutic management.
  
  
  METHODS
  An electronic search of the relevant literature was carried out using medline. Key words used for the final search were "Vasovagal syncope" "pathophysiology" "diagnosis" "tilt-table testing", "imlantableloop recoder", "treatment", "tilt training", isometric muscle tensing", "cardic pacing".
  
  
  RESULTS
  A typical history of VVS is usually sufficient to make the diagnosis without any additional testing. Further testing is required when the diagnosis remains uncertain. Approaches to treatment are largely empirical and this is due to our lack of understanding of the pathophysiology. The management of VVS is often limited to reassuring and advising how to avoid predisposing factors with behaviour modification. For patients with recurrent episodes of syncope and premonitory symptoms, a conservative nondrug approach such as isometric muscle tensing should be considered. Tilt training can also be considered first-line therapy in motivated patients. Nevertheless, if patients still experience sudden recurrent and unpredictable episodes of syncope, a more aggressive treatment strategy is required with need of a prophylactic pharmacologic therapy. Various forms of medical treatment have been proposed but there are limited data from randomized controlled trials to support their effectiveness. The role of cardiac pacing is controversial and its indication should be restricted to patients over the age of 40 with severe recurrent syncope that is refractory to other therapies and in whom episodes include a substantial bradycardic component.
authors.affiliation: Service de Cardiologie, Hôpital Militaire de Tunis.
authors.forename: Thouraya
authors.initials: T
authors.lastname: Filali
authors.forename: Wafa
authors.initials: W
authors.lastname: Fehri
authors.forename: Dhaker
authors.initials: D
authors.lastname: Lahidheb
authors.forename: Nadhem
authors.initials: N
authors.lastname: Hajlaoui
authors.forename: Othmen
authors.initials: O
authors.lastname: Salah
authors.forename: Nadia
authors.initials: N
authors.lastname: Barakett
authors.forename: Zahreddine
authors.initials: Z
authors.lastname: Smiri
authors.forename: Hédi
authors.initials: H
authors.lastname: Mhenni
authors.forename: Habib
authors.initials: H
authors.lastname: Haouala
mesh_terms: D001521:Behavior Therapy; D002304:Cardiac Pacing, Artificial; D018475:Head-Down Tilt; D006801:Humans; D007537:Isometric Contraction / Q000502:physiology; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D019462:Syncope, Vasovagal / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*