Vasovagal (neurocardiogenic) syncope in the clinical practice

Vasovagal syncope (VVS) is the most common type of syncope with the incidence of 21-43%. The aim of this study was to explain difficulties of correct diagnosis of VVS.

Our group comprises 70 patients (24 men, 46 women) at the age of 15-71 years, in whom VVS was verified by the head-up tilt test (HUT-test). We evaluated the type of VVS, admission diagnoses present in the patients, interictal EEG findings and the presence of convulsions during the syncopal states. For statistical processing of the results we used binomial tests for two independent proportions, Fisher-Freeman-Haltons exact test and Cramér's V index.

Out of 70 VVS 35 were vasodepressoric, 19 cardioinhibitive and 16 intermediate. Admission diagnoses present in the patients were: disorders of consciousness of an unknown etiology - 42.9% cases; supposable epilepsy and epilepsy - 30% cases and syncope - 27.1% cases. Interictal EEG was normal in 51.4% cases, nonepileptiform abnormality was present in 48.6% cases. Statistical comparison among particular types of VVS revealed a significant difference in distribution and medial strong association between the type of VVS and the EEG finding (Cramér V=0.35) and also between the type of VVS and the occurrence of convulsions (Cramér V= 0.40).

The results of our study evidently suggest that interdisciplinary cooperation in accurate diagnostics in this field of medicine is needed and that HUT-test has to be in standard diagnostic algorithm in patients with failures of consciousness of an unknown cause.