Can prodromal symptoms predict recurrence of vasovagal syncope?
BACKGROUND
Vasovagal syncope (VVS) is a common symptom with empirical therapy and high recurrence rate. Our goal was to determine whether the pattern of presyncopal prodromal symptoms can predict the recurrence probability of vasovagal syncope.


METHODS
Seventy-nine consecutive patients (male/female: 53/26) with history of VVS and positive tilt table test (TTT) were enrolled in the study and completed the follow-up time for one year. They all had normal electrocardiograms and cardiac echocardiography without underlying disease. All of them were evaluated meticulously for prodromal symptoms (diaphoresis, nausea, palpitation and blurred vision) and frequency of syncopal spells in their past medical history. They received metoprolol at maximum tolerated dose and were taught tilt training as an empirical therapy after TTT.


RESULTS
Fifty-four patients (68.4%) reported at least one of the four main prodromal symptoms. Median syncopal +/- presyncopal spells were 4 episodes. Forty-two patients (53.2%) experienced recurrence of syncope or presyncope during the follow-up period. In recurrent symptomatic patients, diaphoresis had been more significantly reported in their past medical history (p = 0.018) and they had more syncopal spells before TTT (p = 0.001). Age, gender and type of TTT response did not have any effect on the recurrence of VVS.


CONCLUSIONS
Patients with a history of diaphoresis as a prodromal symptom and more pretilt syncopal attacks experience more syncopal or presyncopal spells during follow-up.
Fazelifar
Amir Farjam
AF
Department of Pacemaker and Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran. fazelifar@gmail.com
Basiri
Hosein Ali
HA
Tolooie
Ali
A
Haghjoo
Majid
M
Barakpour
Hamid
H
Emkanjoo
Zahra
Z
Abkenar
Hooman Bakhshandeh
HB
Zeighami
Mahboubeh
M
Asgari
Foroozan
F
Sadr-Ameli
Mohammad Ali
MA
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D013546:Sweating; D019462:Syncope, Vasovagal / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D018667:Tilt-Table Test; D014786:Vision Disorders; D055815:Young Adult
D000319:Adrenergic beta-Antagonists