EVOLUTION OF PATIENTS WITH CLINICAL NEUROCARDIOGENIC (VASOVAGAL) SYNCOPE NOT SUBJECTED TO SPECIFIC TREATMENT

The purpose of this prospective study was to analyze the natural histo ry of patients with clinical neurocardiogenic syncope. The results obt ained with some therapeutic strategies in the prevention of neurocardi ogenic syncope are encouraging. However, the benefit they represent wh en compared with the natural history of syncope has not been clearly e stablished. Fifty-six consecutive patients with either (1) one or more episodes of syncope and a positive head-up tilt test or (2) typical h istory of vasovagal syncope despite a negative tilt test were monitore d during a mean period of 16.1 +/- 10.2 months. Patients were discharg ed without any specific medication. There were no deaths during the fo llow-up period. Recurrences-were found in 5 (8.9%) patients. The risk of recurrence was 7% after 1 year and 15% after 21 months. The prognos is of patients with clinical neurocardiogenic syncope is excellent as far as survival is concerned. Recurrences of episodes without specific treatment were uncommon after diagnosis had taken place. This finding strengthens the need to evaluate the effect of drugs with placebo con trol groups and to select the highest-risk group for treatment.