Vasovagal Syncope: Risks and Impact on Everyday Living

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Vasovagal SyncopeRisks and Impact on Everyday
Living

• JC Deharo, CHU Marseille

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Syncope 3 of men 3.5 of women
Framingham cohort
Soteriades et al, NEJM 2002
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101 pts referred to a syncope unit (2003)
Unknown Arrh. / Cond Dist NCS
10-39 (n20)
40-69 (n38)
70 (n43)
Age (y.)
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Framingham cohort
Soteriades et al, NEJM 2002
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Risk Factor for Syncope Recurrence after a
positive HUT In Patients with Syncope
Syncope free
Sheldon al, Circulation 1996
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497 pts with suspected VVS 24 pts (4) with
positive HUT and 2 syncope in the previous
year FU 14.8 6.5 months 13 patients with
syncope recurrence
Jego et al., AHA 2003
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High recurrent syncope risk group

• 6 syncope or 3 syncope in the last 2 years
• Motor vehicle crash 12
• Driving restrictions 40
• Bone fractures 10
• gt 15 days of work missed in past year 36

Connolly et al, JAMA 2003
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Mean number of syncope episodes (N101 pts
referred to a syncope unit)

• Lifetime Last 2 y. Last y.
• NCS 3.93 2.56 2.17
• Arrhythmia/ 1.8 1.6 1.45
• Cond. Dist.
• Unknown 2.55 1.83 1.66

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101 pts referred to a syncope unit (2003)
Trauma
VVS
Other NCS
Arrhythmia Cond. Dist
Unknown
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EQ-5D questionnaire
Your own health state today ?
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Number of syncopal spells and HRQL
N131 pts with SVV
Rose et al, J Clin Epidemiol 2000
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Prevalence of impaired health
N131 pts with SVV
X 2
X 10
From Rose et al, J Clin Epidemiol 2000
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Number of syncopal spells and HRQL
Rose et al, J Clin Epidemiol 2000
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23 pts (age 61.8 15.2 years, 19 males) 6
syncope (lifetime) and 2 syncope last y.
Deharo et al. PACE 2001
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SVV pts vs HF pts
N271 pts Referred for HUT
SF36 Questionnaire
NS
NS
P0.0001
NS
NS
P0.009
P0.0001
NS
Baron-Esquivias, Med Clin 2003
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SF-36 questionnaire (mediane) General population
vs SVV pts
Baron-Esquivias, Med Clin 2003
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SF-36 questionnaire (mediane) in males
Baron-Esquivias, Med Clin 2003
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SF-36 questionnaire (mediane) in females
Baron-Esquivias, Med Clin 2003
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Anxiety and VVS

• Cohen et al., PACE 2000 23 837-41

p0.017
BAI score
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Psychiatric disorders and VVS

• "Prevalence of psychiatric disorders in syncope
  patients" (Kouakam et al, Am J Cardiol 2002)
• 16 / 25 pts with positive HUT
• Anxiety 8/25
• Panic attacks 5/25
• Dépression 3/25
• "Cognitive behavioural therapy as a potential
  treatment for VVS" (Newton et al, Europace 2003)

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VVS and motor vehicle driving
1st syncope episode 4/23
9.4
Huagui et al, AJC 2000
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Vasovagal syncope

• Private drivers Vocational drivers
• Single / Mild No restrictions No restrictions
• (unless it occured during high risk
  activity)
• Severe Until symptoms Permanent restriction
• controlled (unless effective trt established)

ESC guidelines on Syncope, 2004
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Conclusions

• Vasovagal syncope is a benign affection
• The great majority of patients do not warrant
  medical attention except for counseling and
  reassurance
• Up to 50 of the patients experience recurrences
• Frequent recurrences may alter considerably
  quality of life and disturb occupational or
  working activities.
• Lack of specific treatment is a main concern for
  patient management