ANXIETY NEUROSIS AND UNEXPLAINED SYNCOPE OF PRESUMED VASO-VAGAL ORIGIN

The impact of anxiety neurosis on the diagnosis and treatment of patie nts with unexplained syncope (S) was assessed in 178 patients (91 wome n and 87 men) with an average age of 36.5 +/- 20 years, presenting wit h 10.7 +/- 24 episodes of S). None had evidence of underlying cardiac disease apart from 7 patients with mild hypertension. All patients und erwent a tilt test (TT) at 60 degrees for 45 minutes. A bolus of isopr oterenol was injected intravenously in subjects with negative TT. Afte r the test, the patients were classified according to the presence (n = 38) or absence (n = 140) of anxiety neurosis based on the DSM III-R diagnostic. The TT was positive in 76 patients, 9 of whom had a cardio inhibitory reaction with prolonged asystole. Patients with anxiety had more episodes of S (24 +/- 43 versus 7 +/- 13; p = 0.001), a shorter interval between S (11.5 +/- 23 months versus 12.5 +/- 20 months, p = 0.02) but more negative TT (27/38 versus 75/140; p = 0.05). One hundre d and sixty-eight patients were followed up; 10 were lost to follow-up . Preventive treatment was undertaken in 59 patients who were represen tative of the whole group with respect to age (30 +/- 18 years 39 +/- 21 years; p = 0,004). After an average follow-up of 24.5 +/- 15 months , 26 patients (15 %) experienced a recurrence of S. The recurrence rat e was identical in patients with positive and negative TT and in treat ed and untreated cases. On the other hand, recurrence was higher in th ose with anxiety (12/25 versus 14/117; p = 0.001) who also had less im provement of symptoms (12/15 versus 74/120; p = 0.001). The ''anxiety' ' variable was therefore identified as being the only predictive facto r for recurrence of syncope. The authors conclude that in patients ref erred for investigation of unexplained syncope, some suffer from anxie ty neurosis, in whom the TT is usually negative, and have a higher ris k of recurrence. They justify a specific therapeutic management.