Vasovagal syncope: poorly understood, but well handled

Abstract

This editorial refers to ‘Cardiac autonomic disturbances in patients with vasovagal syndrome: comparison between iodine-123-metaiodobenzylguanidine myocardial scintigraphy and heart rate variability’ by G. Kochiadakis et al ., on page 1352 In this issue of the Journal, Kochiadakis and co-workers from Heraklion University Hospital in Athens report on autonomic regulation in patients with vasovagal syncope (VVS) diagnosed with tilt table testing.1 They measured heart rate variability (HRV) and assessed cardiac sympathetic innervation using 123-I-meta-iodobenzylguanidine (MIBG) scintigraphy. The main finding of this study was that adrenergic cardiac innervation showed defects in the left ventricle in patients with VVS. This finding was not associated with the type of response (cardioinhibitory or vasodepressor) during tilt table testing. However, the study critics may object that the infrequent blood pressure measurements rather than continuous non-invasive blood pressure measurement during tilt table testing did not allow the accurate classification of the response. In contrast to this finding, HRV, as a marker of the resulting efferent vasomotor activity at the level …