Vasovagal syncope

Abstract

Malignant VVS must be distinguished from youthful vasovagal syncope. Treatment of MVVS can be chosen by tilt-testing. CI-MVVS is well treated by DDI pacing with rate hysteresis whereas no perfect drug exists for VD-MVVS. At present, a combination of scopolamine and Clonidine appears to be the best of a poor selection. In the future early detection of impending syncope even before the patient is aware by means of sensors and application of sophisticated pacing modes may offer the best option, although it may ultimately be necessary to combine sophisticated sensors, dual chamber pacing and an implantable drug dispenser releasing small doses of dihydroergotamine in order to achieve anything approaching 100% symptom control.