Syncope Recurrence in Patients with Neurocardiogenic Syncope

pp 155-160

Abstract

An overall population of 397 patients (p) from a Syncope Centre with diagnosis of syncope (S) was regularly followed up from 1991 to 1996. We have selected 70 p(M/F:35/35) suffering from neurocardiogenic syncope (mean 30 ±16 yr). This group was studied by means of a protocol which included history, physical examination, carotid sinus massage, blood pressure control (supine and orthostatic), neurologic and EEG evaluation, ECG, echocardiogram, 24 hr- Holter monitoring and tilt-table test. The diagnosis was reached mainly based on a typical history of neurocardiogenic syncope in abscence of another cause of syncope with or without a positive tilt-table test. Based on the interrogation of the patients and their close relatives, we managed to build the chronology of the syncopal episodes up to the first examination and with a further 4 year follow-up. No pharmacological treatment was indicated. Once the diagnosis was reached, the patient was given instructions as how to avoid triggering factors or to recognise preceding symptoms in order to avoid the crisis. The Kaplan-Meier method was used to analyse the recurrence of episodes. In the four years previous to the first visit, 74% of the population had recurrences after the first historical episode. After making the diagnose, only 13% recurred in the same period of time, which resulted in a significant difference (p< 0.001). The natural history of patients with neurocardiogenic syncope has not yet been cleared up. Attention has been focused increasingly on how best to treat these patients. These findings suggest that the natural evolution of the disease could be modified by accurately diagnosing and indicating preventive attitudes, avoiding thus inappropriate treatments in these patients.