R Ross1, S Parry, M Norton, J L Newton. 1. Falls and Syncope Service, University of Newcastle, Royal Victoria Infirmary, Newcastle NE1 4LP, UK.
Abstract
BACKGROUND: Natural history of Vasovagal syndrome (Neurocardiogenic; NCS) is unclear. AIM: To examine symptoms in a large cohort with head up tilt diagnosed NCS. METHODS: Questionnaires were posted to 485 patients with NCS. Data included demographic details, age at referral, presenting and on-going symptoms (syncope, dizziness and falls), symptom frequency (daily, weekly, monthly) and burden. RESULTS: A total of 418 questionnaires were returned (response rate 86%), 67% female. Median age at first presentation 60 (range 10-90), with men younger (54 vs. 63; P = 0.01). Seventy percent presented with syncope. Median follow-up 5 years (1-8). At follow-up 147(35%) were asymptomatic. The asymptomatic group was older (73 vs. 65; P = 0.0001) with more males (39 vs. 29%; P = 0.04). Those presenting with syncope were more likely to be symptom-free than those with dizziness (P < 0.02). Symptom frequency was greatest for those reporting dizziness at follow-up (P < 0.05). Sixty (22%) reported symptoms never preventing activities [predominantly those reporting dizziness (P = 0.04)]. Although there was a significant reduction of symptoms overall, there was a significant increase in those reporting dizziness only (P < 0.0001). CONCLUSION: Of those with NCS, 35% will be symptom-free at 5 years regardless of presenting symptom or treatment received.
BACKGROUND: Natural history of Vasovagal syndrome (Neurocardiogenic; NCS) is unclear. AIM: To examine symptoms in a large cohort with head up tilt diagnosed NCS. METHODS: Questionnaires were posted to 485 patients with NCS. Data included demographic details, age at referral, presenting and on-going symptoms (syncope, dizziness and falls), symptom frequency (daily, weekly, monthly) and burden. RESULTS: A total of 418 questionnaires were returned (response rate 86%), 67% female. Median age at first presentation 60 (range 10-90), with men younger (54 vs. 63; P = 0.01). Seventy percent presented with syncope. Median follow-up 5 years (1-8). At follow-up 147(35%) were asymptomatic. The asymptomatic group was older (73 vs. 65; P = 0.0001) with more males (39 vs. 29%; P = 0.04). Those presenting with syncope were more likely to be symptom-free than those with dizziness (P < 0.02). Symptom frequency was greatest for those reporting dizziness at follow-up (P < 0.05). Sixty (22%) reported symptoms never preventing activities [predominantly those reporting dizziness (P = 0.04)]. Although there was a significant reduction of symptoms overall, there was a significant increase in those reporting dizziness only (P < 0.0001). CONCLUSION: Of those with NCS, 35% will be symptom-free at 5 years regardless of presenting symptom or treatment received.