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Vasovagal syncope

MedGen UID:
12060
•Concept ID:
C0042420
•
Disease or Syndrome
Synonyms: Faint, Neurally Mediated; Faints, Neurally Mediated; Neurally Mediated Faint; Neurally Mediated Faints; Neurocardiogenic Syncope; Neurocardiogenic Syncopes; Neurogenic Syncope; Neurogenic Syncopes; Syncope, Neurocardiogenic; Syncope, Neurogenic; Syncope, Vasodepressor; Syncope, Vasovagal; Syncope, Vasovagal, Neurally-Mediated; Syncopes, Neurocardiogenic; Syncopes, Neurogenic; Syncopes, Vasodepressor; Syncopes, Vasovagal; Vasodepressor Syncope; Vasodepressor Syncopes; Vasovagal Syncope; Vasovagal Syncopes
SNOMED CT: Vasovagal syncope (398665005); Vaso vagal episode (398665005); Vasodepressor syncope (398665005); Neurally-mediated syncope (398665005); Vasovagal attack (398665005); Gower's syndrome (398665005)
 
HPO: HP:0012668

Definition

A vasovagal episode or vasovagal syncope is the most common form of reflex syncope. Reflex syncope is a general term used to describe types of syncope resulting from a failure in autoregulation of blood pressure, and ultimately, in cerebral perfusion pressure resulting in transient loss of consciousness. The mechanisms responsible for this are complex and involve both depression of cardiac output as well as a decrease in vascular tone. [from HPO]

Professional guidelines

PubMed

Management strategies for vasovagal syncope.
Ali M, Pachon Maetos JC, Kichloo A, Masudi S, Grubb BP, Kanjwal K
Pacing Clin Electrophysiol 2021 Dec;44(12):2100-2108. Epub 2021 Nov 23 doi: 10.1111/pace.14402. PMID: 34748224
2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW
Circulation 2017 Aug 1;136(5):e60-e122. Epub 2017 Mar 9 doi: 10.1161/CIR.0000000000000499. PMID: 28280231
2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope.
Sheldon RS, Grubb BP 2nd, Olshansky B, Shen WK, Calkins H, Brignole M, Raj SR, Krahn AD, Morillo CA, Stewart JM, Sutton R, Sandroni P, Friday KJ, Hachul DT, Cohen MI, Lau DH, Mayuga KA, Moak JP, Sandhu RK, Kanjwal K
Heart Rhythm 2015 Jun;12(6):e41-63. Epub 2015 May 14 doi: 10.1016/j.hrthm.2015.03.029. PMID: 25980576Free PMC Article

Recent clinical studies

Etiology

Cardioneuroablation: a new treatment for vasovagal syncope.
Saglietto A, Falasconi G, Penela D, Francia P, Viveros D, Berruezo A, Russo V, Brignole M, Aksu T, Anselmino M, De Ferrari GM, Dusi V
J Cardiovasc Med (Hagerstown) 2025 Mar 1;26(3):131-142. Epub 2025 Jan 27 doi: 10.2459/JCM.0000000000001703. PMID: 39976065
Vasovagal syncope: An overview of pathophysiological mechanisms.
Longo S, Legramante JM, Rizza S, Federici M
Eur J Intern Med 2023 Jun;112:6-14. Epub 2023 Apr 6 doi: 10.1016/j.ejim.2023.03.025. PMID: 37030995
Cardioneuroablation for Reflex Syncope: Efficacy and Effects on Autonomic Cardiac Regulation-A Prospective Randomized Trial.
Piotrowski R, Baran J, Sikorska A, Krynski T, Kulakowski P
JACC Clin Electrophysiol 2023 Jan;9(1):85-95. Epub 2022 Aug 28 doi: 10.1016/j.jacep.2022.08.011. PMID: 36114133
Pacing for vasovagal syncope: Tips for use in practice.
Morillo CA, Brignole M
Auton Neurosci 2022 Sep;241:102998. Epub 2022 Jun 2 doi: 10.1016/j.autneu.2022.102998. PMID: 35696879
Assessment and Treatment of Syncope.
Shen WK, Sheldon RS
JAMA Cardiol 2017 Aug 1;2(8):920-921. doi: 10.1001/jamacardio.2017.1784. PMID: 28614562

Diagnosis

Cardioneuroablation for vasovagal syncope: A systematic review and meta-analysis.
Vandenberk B, Lei LY, Ballantyne B, Vickers D, Liang Z, Sheldon RS, Chew DS, Aksu T, Raj SR, Morillo CA
Heart Rhythm 2022 Nov;19(11):1804-1812. Epub 2022 Jun 16 doi: 10.1016/j.hrthm.2022.06.017. PMID: 35716859
Cardioneuroablation for vasovagal syncope and atrioventricular block: A step-by-step guide.
Aksu T, Gupta D, D'Avila A, Morillo CA
J Cardiovasc Electrophysiol 2022 Oct;33(10):2205-2212. Epub 2022 Apr 9 doi: 10.1111/jce.15480. PMID: 35362165
Management strategies for vasovagal syncope.
Ali M, Pachon Maetos JC, Kichloo A, Masudi S, Grubb BP, Kanjwal K
Pacing Clin Electrophysiol 2021 Dec;44(12):2100-2108. Epub 2021 Nov 23 doi: 10.1111/pace.14402. PMID: 34748224
The pathophysiology of the vasovagal response.
Jardine DL, Wieling W, Brignole M, Lenders JWM, Sutton R, Stewart J
Heart Rhythm 2018 Jun;15(6):921-929. Epub 2017 Dec 12 doi: 10.1016/j.hrthm.2017.12.013. PMID: 29246828Free PMC Article
Vasovagal syncope.
Chiocca EM
Nursing 2003 Jul;33(7):96. doi: 10.1097/00152193-200307000-00069. PMID: 12851506

Therapy

Vasovagal syncope: An overview of pathophysiological mechanisms.
Longo S, Legramante JM, Rizza S, Federici M
Eur J Intern Med 2023 Jun;112:6-14. Epub 2023 Apr 6 doi: 10.1016/j.ejim.2023.03.025. PMID: 37030995
Cardioneuroablation for Reflex Syncope: Efficacy and Effects on Autonomic Cardiac Regulation-A Prospective Randomized Trial.
Piotrowski R, Baran J, Sikorska A, Krynski T, Kulakowski P
JACC Clin Electrophysiol 2023 Jan;9(1):85-95. Epub 2022 Aug 28 doi: 10.1016/j.jacep.2022.08.011. PMID: 36114133
Cardioneuroablation for vasovagal syncope: A systematic review and meta-analysis.
Vandenberk B, Lei LY, Ballantyne B, Vickers D, Liang Z, Sheldon RS, Chew DS, Aksu T, Raj SR, Morillo CA
Heart Rhythm 2022 Nov;19(11):1804-1812. Epub 2022 Jun 16 doi: 10.1016/j.hrthm.2022.06.017. PMID: 35716859
Cardioneuroablation for vasovagal syncope and atrioventricular block: A step-by-step guide.
Aksu T, Gupta D, D'Avila A, Morillo CA
J Cardiovasc Electrophysiol 2022 Oct;33(10):2205-2212. Epub 2022 Apr 9 doi: 10.1111/jce.15480. PMID: 35362165
Carotid sinus syndrome.
Seifer C
Cardiol Clin 2013 Feb;31(1):111-21. doi: 10.1016/j.ccl.2012.10.002. PMID: 23217692

Prognosis

Incidence of vasovagal syncope in Mohs surgery.
Stashower J, Strahan JE
Arch Dermatol Res 2022 Sep;314(7):709-710. Epub 2021 Mar 12 doi: 10.1007/s00403-021-02215-0. PMID: 33710391
2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW
Circulation 2017 Aug 1;136(5):e60-e122. Epub 2017 Mar 9 doi: 10.1161/CIR.0000000000000499. PMID: 28280231
Head-Up Tilt.
Xu J, Yang L, Zhang Q, Li S, Qiao Z, Fang Y, Zhao G, Wang Q, Liu G
Int Heart J 2015;56(5):500-4. Epub 2015 Sep 11 doi: 10.1536/ihj.15-039. PMID: 26370369
Vagally mediated atrioventricular block: pathophysiology and diagnosis.
Alboni P, Holz A, Brignole M
Heart 2013 Jul;99(13):904-8. Epub 2013 Jan 2 doi: 10.1136/heartjnl-2012-303220. PMID: 23286970
Carotid sinus syndrome.
Seifer C
Cardiol Clin 2013 Feb;31(1):111-21. doi: 10.1016/j.ccl.2012.10.002. PMID: 23217692

Clinical prediction guides

Cardioneuroablation for vasovagal syncope: A systematic review and meta-analysis.
Vandenberk B, Lei LY, Ballantyne B, Vickers D, Liang Z, Sheldon RS, Chew DS, Aksu T, Raj SR, Morillo CA
Heart Rhythm 2022 Nov;19(11):1804-1812. Epub 2022 Jun 16 doi: 10.1016/j.hrthm.2022.06.017. PMID: 35716859
Prediction of the Time to Syncope Occurrence in Patients Diagnosed with Vasovagal Syncope.
Kostoglou K, Schondorf R, Benoit J, Balegh S, Mitsis GD
Acta Neurochir Suppl 2018;126:313-316. doi: 10.1007/978-3-319-65798-1_61. PMID: 29492581
2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW
Circulation 2017 Aug 1;136(5):e60-e122. Epub 2017 Mar 9 doi: 10.1161/CIR.0000000000000499. PMID: 28280231
Head-Up Tilt.
Xu J, Yang L, Zhang Q, Li S, Qiao Z, Fang Y, Zhao G, Wang Q, Liu G
Int Heart J 2015;56(5):500-4. Epub 2015 Sep 11 doi: 10.1536/ihj.15-039. PMID: 26370369
Vagally mediated atrioventricular block: pathophysiology and diagnosis.
Alboni P, Holz A, Brignole M
Heart 2013 Jul;99(13):904-8. Epub 2013 Jan 2 doi: 10.1136/heartjnl-2012-303220. PMID: 23286970

Recent systematic reviews

Midodrine for Recurrent Vasovagal Syncope: A Systematic Review and Meta-analysis of Randomized Control Trials.
Mhanna M, Beran A, Mhanna AS, Al-Abdouh A, Jabri A, Numan MJ, Alsaiqali M, Musallam R, Zerihun K, Mahmood A
Am J Ther 2024 Jan-Feb 01;31(1):e87-e91. Epub 2022 Apr 20 doi: 10.1097/MJT.0000000000001513. PMID: 35703495
An unusual case of neurocardiogenic syncope: A case report and systematic review.
Tan WW, Adler M, Rochow S, Myint PK
J R Coll Physicians Edinb 2023 Mar;53(1):19-22. Epub 2023 Jan 15 doi: 10.1177/14782715221147969. PMID: 36642954
Cardioneuroablation for vasovagal syncope: A systematic review and meta-analysis.
Vandenberk B, Lei LY, Ballantyne B, Vickers D, Liang Z, Sheldon RS, Chew DS, Aksu T, Raj SR, Morillo CA
Heart Rhythm 2022 Nov;19(11):1804-1812. Epub 2022 Jun 16 doi: 10.1016/j.hrthm.2022.06.017. PMID: 35716859
Midodrine for the prevention of vasovagal syncope: a systematic review and meta-analysis.
Lei LY, Raj SR, Sheldon RS
Europace 2022 Jul 21;24(7):1171-1178. doi: 10.1093/europace/euab323. PMID: 35025999Free PMC Article
Did This Patient Have Cardiac Syncope?: The Rational Clinical Examination Systematic Review.
Albassam OT, Redelmeier RJ, Shadowitz S, Husain AM, Simel D, Etchells EE
JAMA 2019 Jun 25;321(24):2448-2457. doi: 10.1001/jama.2019.8001. PMID: 31237649

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