vasovagal syncope: risks and impact on everyday living jc deharo, chu marseille
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Vasovagal Syncope:Risks and Impact on Everyday
Living
JC Deharo, CHU Marseille
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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
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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
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Number of syncopes per patient
Nu
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f pat
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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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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
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60
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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
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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
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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
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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
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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
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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
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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