An Update on the Treatment of Vasovagal Syncope

In general, the initial “treatment” of all forms of neurally-mediated reflex syncope comprises reassurance as to the benign nature of the syndrome, education regarding avoidance of triggering events and predisposing factors, recognition of premonitory symptoms and manoeuvres to abort the episode, the avoidance of volume depletion and prolonged upright posture. The above measures are sufficient for the vast majority of patients affected by vasovagal syncope. Additional treatment may be necessary in high risk or high frequency settings which have been defined by the ESC Task force on Syncope when: ñ syncope is very frequent, i.e. alters the quality of life ñ syncope is recurrent and unpredictable (absence of premonitory symptoms) and exposes patients to a “high risk” of trauma ñ syncope occurs during the prosecution of a “high risk” activity (e.g. driving, machine operation, flying, competitive athletics, etc.)