From the Guidelines
The treatment for vasovagal syncope reflex is primarily focused on physical counterpressure maneuvers (PCMs), which have been shown to be effective in reducing the frequency of syncope episodes 1.
Treatment Options
- Physical Counterpressure Maneuvers (PCMs): PCMs, such as leg crossing or hand grip, can help increase blood pressure and prevent syncope in patients with vasovagal syncope 1.
- Midodrine: Midodrine may be useful in patients with recurrent vasovagal syncope, particularly in those with no history of hypertension, heart failure, or urinary retention 1.
- Lifestyle Modifications: Encouraging increased salt and fluid intake, reducing or withdrawing medications that cause hypotension, and avoiding trigger events may be beneficial in selected patients with vasovagal syncope 1.
Pharmacological Therapy
- Beta Blockers: Beta blockers may be considered in patients 42 years of age or older with recurrent vasovagal syncope, but their effectiveness is not well established 1.
- Fludrocortisone: Fludrocortisone may be considered in patients with recurrent vasovagal syncope and inadequate response to salt and fluid intake, but its effectiveness is not well established 1.
Other Therapies
- Tilt Training: Tilt training may be considered in highly motivated, young patients with recurrent vasovagal symptoms, but its effectiveness is not well established 1.
- Cardiac Pacing: Cardiac pacing may be considered in patients with cardioinhibitory or mixed carotid sinus syndrome, but its effectiveness in vasovagal syncope is not well established 1.
From the Research
Treatment Options for Vasovagal Syncope
The treatment for vasovagal syncope (VVS) typically involves a combination of non-pharmacological and pharmacological approaches. Some of the key treatment options include:
- Patient education about the mechanism of fainting and the non-lethal nature of VVS 2
- Increases in dietary salt and water intake to help prevent episodes of syncope 2, 3, 4
- Use of compression garments to help improve blood flow and prevent fainting 2
- Physical counter-maneuvers, such as tensing the muscles or crossing the legs, to help increase blood pressure and prevent syncope 2, 3, 4
- Tilt-training, which involves gradually increasing the duration and frequency of standing or sitting to help the body adapt to changes in position 2
Pharmacological Treatments
For patients who do not respond to non-pharmacological treatments, medications may be prescribed to help manage VVS. Some of the medications that have been shown to be effective in reducing the frequency of syncope episodes include:
- Midodrine, which helps to increase blood pressure and prevent fainting 5, 4
- Fludrocortisone, which helps to increase fluid volume and prevent dehydration 5
- Beta-blockers, which help to regulate heart rate and blood pressure 5, 3
- Norepinephrine transport inhibitors, which help to increase blood pressure and prevent fainting 5
- Fluoxetine and atomoxetine, which may be suitable candidates for VVS therapy 4
Device-Based Therapies
For patients who do not respond to pharmacological treatments, device-based therapies such as permanent pacemakers may be considered. These devices can help to regulate heart rate and blood pressure, and may be effective in preventing recurrent episodes of syncope 3, 6. Closed-loop stimulation, which involves the use of a pacemaker to detect and respond to changes in blood pressure, may be a viable alternative for preventing recurrent VVS episodes 6.