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Vasovagal Syncope: Risks and Impact on Everyday Living

Vasovagal Syncope: Risks and Impact on Everyday Living . JC Deharo, CHU Marseille. Framingham cohort. Syncope 3% of men 3.5% of women. Soteriades et al, NEJM 2002. 101 pts referred to a syncope unit (2003). Unknown Arrh. / Cond Dist NCS. 10-39 (n=20). 40-69 (n=38). ≥70 (n=43).

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Vasovagal Syncope: Risks and Impact on Everyday Living

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  1. Vasovagal Syncope:Risks and Impact on Everyday Living JC Deharo, CHU Marseille

  2. Framingham cohort Syncope 3% of men 3.5% of women Soteriades et al, NEJM 2002

  3. 101 pts referred to a syncope unit (2003) Unknown Arrh. / Cond Dist NCS 10-39 (n=20) 40-69 (n=38) ≥70 (n=43) Age (y.)

  4. Framingham cohort Soteriades et al, NEJM 2002

  5. Risk Factor for Syncope Recurrence after a positive HUT In Patients with Syncope Syncope free Sheldon al, Circulation 1996

  6. 497 pts with suspected VVS 24 pts (4%) with positive HUT and ≥ 2 syncope in the previous year FU : 14.8 ± 6.5 months 13 patients with syncope recurrence Jego et al., AHA 2003

  7. High recurrent syncope risk group ≥ 6 syncope or ≥ 3 syncope in the last 2 years • Motor vehicle crash : 12 % • Driving restrictions : 40 % • Bone fractures : 10 % • > 15 days of work missed in past year : 36 % Connolly et al, JAMA 2003

  8. Mean number of syncope episodes (N=101 pts referred to a syncope unit) Lifetime Last 2 y. Last y. NCS 3.93 2.56 2.17 Arrhythmia/ 1.8 1.6 1.45 Cond. Dist. Unknown 2.55 1.83 1.66

  9. 101 pts referred to a syncope unit (2003) Trauma VVS Other NCS Arrhythmia Cond. Dist Unknown

  10. EQ-5D questionnaire Your own health state today ?

  11. Number of syncopal spells and HRQL N=131 pts with SVV Rose et al, J Clin Epidemiol 2000

  12. Prevalence of impaired health N=131 pts with SVV X 2 X 10 From Rose et al, J Clin Epidemiol 2000

  13. Number of syncopal spells and HRQL Rose et al, J Clin Epidemiol 2000

  14. 23 pts (age: 61.8 ± 15.2 years, 19 males)≥ 6 syncope (lifetime) and 2 syncope last y. Deharo et al. PACE 2001

  15. SVV pts vs HF pts N=271 pts Referred for HUT SF36 Questionnaire NS NS P=0.0001 NS NS P=0.009 P=0.0001 NS Baron-Esquivias, Med Clin 2003

  16. SF-36 questionnaire (mediane) General population vs SVV pts Baron-Esquivias, Med Clin 2003

  17. SF-36 questionnaire (mediane) in males Baron-Esquivias, Med Clin 2003

  18. SF-36 questionnaire (mediane) in females Baron-Esquivias, Med Clin 2003

  19. Anxiety and VVS • Cohen et al., PACE 2000; 23: 837-41 p=0.017 BAI score

  20. Psychiatric disorders and VVS • "Prevalence of psychiatric disorders in syncope patients"(Kouakam et al, Am J Cardiol 2002) • 16 / 25 pts with positive HUT • Anxiety 8/25 • Panic attacks 5/25 • Dépression 3/25 • "Cognitive behavioural therapy as a potential treatment for VVS" (Newton et al, Europace 2003)

  21. VVS and motor vehicle driving 1st syncope episode 4/23 9.4% Huagui et al, AJC 2000

  22. Vasovagal syncope Private drivers Vocational drivers Single / Mild No restrictions No restrictions (unless it occured during high risk activity) Severe Until symptoms Permanent restriction controlled (unless effective trt established) ESC guidelines on Syncope, 2004

  23. Conclusions • Vasovagal syncope is a benign affection • The great majority of patients do not warrant medical attention except for counseling and reassurance • Up to 50% of the patients experience recurrences • Frequent recurrences may alter considerably quality of life and disturb occupational or working activities. • Lack of specific treatment is a main concern for patient management

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