Vasovagal Syncope: Risks and Impact on Everyday Living JC Deharo, CHU Marseille

Vasovagal Syncope:Risks and Impact on Everyday

Living

JC Deharo, CHU Marseille

0

5

10

15

20

25

30

35

40

Cardiac Unknown Stroke Seizure Vasovagal Orthostatic Medications Other

Soteriades et al, NEJM 2002

Syncope

3% of men3.5% of women

Framingham cohort

70%

10%

20%

73,68%

10,52%

15,78%

48,83%

34,88%

18,60%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

po

urc

enta

ges

10 à 39 (n=20) 40 à 69 (n=38) 70 et plus (n=43)

âge (ans)

Figure 4: Fréquences des étiologies de la syncope suivant l'âge

Etiologie inconnue

Tr du rythme - Tr de la conduction

Syncopes neurocardiogéniques

101 pts referred to a syncope unit (2003)

UnknownArrh. / Cond DistNCS

Age (y.)

10-39 (n=20) 40-69 (n=38) ≥70 (n=43)

Soteriades et al, NEJM 2002

Framingham cohort

Risk Factor for Syncope Recurrence after a positive HUT In Patients with Syncope

Sheldon al, Circulation 1996

Syncope free

0

1

2

3

4

5

1 2 3 4 5

Number of syncopes per patient

Nu

mb

er o

f pat

ien

ts

Jego et al., AHA 2003

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

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 %

• > 15 days of work missed in past year : 36 %

Connolly et al, JAMA 2003

Mean number of syncope episodes (N=101 pts referred to a syncope unit)

Lifetime Last 2 y. Last y.

NCS 3.93 2.56 2.17

Arrhythmia/ 1.8 1.6 1.45Cond. Dist.

Unknown 2.55 1.83 1.66

37,50%

71,40%

42,90%

61,10%

0,00%

10,00%

20,00%

30,00%

40,00%

50,00%

60,00%

70,00%

80,00%

trau

mat

ism

es

Syncopesvasovagales

Autres syncopesneurocardiogéniques

Tr du rythme - Tr dela conduction

Etiologie inconnue

étiologies

Figure 8: Fréquences des traumatismes suivant l'étiologie de la syncope101 pts referred to a syncope unit (2003)

VVS OtherNCS

ArrhythmiaCond. Dist

Unknown

Tra

uma

Your own health state today ?

EQ-5D questionnaire

Number of syncopal spells and HRQL

Rose et al, J Clin Epidemiol 2000

N=131 pts with SVV

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5

10

15

20

25

30

35

40

45

50

Mobility Usual activities Self-care Pain/Discomfort Anxiety/Depression

Population norms Syncope pts

Prevalence of impaired health

From Rose et al, J Clin Epidemiol 2000

X 10X 2

N=131 pts with SVV

Number of syncopal spells and HRQL

Rose et al, J Clin Epidemiol 2000

0

20

40

60

80

100

Before implant DDI DDDR

Eu

roq

ol i

nd

ex

23 pts (age: 61.8 ± 15.2 years, 19 males) ≥ 6 syncope (lifetime) and 2 syncope last y.

Deharo et al. PACE 2001

0

20

40

60

80

100

Mentalhealth

Vitality Physicalfunctioning

Physical rolefunction

Emotionalrole function

Social rolefunction

Bodily pain Generalhealth

SVV HF II-III

SVV pts vs HF pts

P=0.009

NSP=0.0001 NS

P=0.0001

NS

NSNS

Baron-Esquivias, Med Clin 2003

N=271 pts Referred for HUT

SF36Questionnaire

60

70

80

90

100

Physicalfunctionning

Physical rolefunction

Bodily pain Generalhealth

Vitality Social rolefunction

Emotionalrole function

Mental health

General population SVV pts

SF-36 questionnaire (mediane)General population vs SVV pts

Baron-Esquivias, Med Clin 2003

60

70

80

90

100

Physicalfunctionning

Physical rolefunction

Bodily pain Generalhealth

Vitality Social rolefunction

Emotionalrole function

Mental health

Males general population Males SVV

SF-36 questionnaire (mediane) in males

Baron-Esquivias, Med Clin 2003

50

60

70

80

90

100

Physicalfunctionning

Physical rolefunction

Bodily pain Generalhealth

Vitality Social rolefunction

Emotionalrole function

Mental health

Females general population Females SVV

SF-36 questionnaire (mediane) in females

Baron-Esquivias, Med Clin 2003

Anxiety and VVS

• Cohen et al., PACE 2000; 23: 837-41

0

5

10

15

20

25

HUT + (N=29) HUT - (N=37)

BAIscore

p=0.017

• "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)

Psychiatric disorders and VVS

VVS and motor vehicle driving

0

50

100

150

200

250

Pts (N)

HUT for syncope Syncope during driving

9.4%

1st syncopeepisode 4/23

Huagui et al, AJC 2000

Vasovagal syncope

Private drivers Vocational drivers

Single / Mild No restrictions No restrictions

(unless it occured during

high risk activity)

Severe Until symptoms Permanent restrictioncontrolled (unless effective trt established)

ESC guidelines on Syncope, 2004

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