Clinical characteristics of patients with vasovagal reactions presenting as unexplained syncope

Objective To describe the clinical characteristics of vasovagal syncope (VV S) in patients presenting to a tertiary referral centre with unexplained sy ncope, in whom the diagnosis of WS was confirmed by tilt table testing (HUT ) and in whom other causes of syncope excluded. Design Prospective study of 62 consecutive patients with more than two epis odes of syncope in the past year. Setting A regional tertiary referral centre for patients with unexplained s yncope. Patients Sixty-two patients, mean age 50 +/- 21 years, 39 female, were stud ied. Mean duration of symptoms was 5 years. Average frequency of attacks wa s one episode per week. Interventions Detailed semi-structured questionnaires were completed regard ing presenting symptoms. Results In over one-third of patients, episodes occurred suddenly, with no prodromal features. In those with prodrome. 71% had autonomic symptoms, but 27% had palpitations or dyspnoea and 21% had chest pain. Eleven percent of patients denied known provocative features. In the remain der, the most common were prolonged standing (37%), hot weather (27%) and l ack of food (23%). One-fifth had symptoms sitting and 5% whilst driving. Seventy-five percent of patients suffered after effects, the most common be ing severe fatigue. Over half sustained an injury during syncope, and 13% s ustained a fracture. Unwitnessed episodes occurred in 25%. Pallor was repor ted in half the cases, sweating in 13% and myoclonus in 5%. Conclusions Atypical presentations of WS occur in many patients referred to a tertiary referral centre. Knowledge of the clinical characteristics of u nexplained syncope for which WS is the attributable diagnosis should assist in appropriate management of such patients. (Europace 2001; 3: 141-146) (C ) 2001 The European Society of Cardiology.