Background: Vasovagal syncope (VVS) is a common symptom with empirical therapy and
high recurrence rate. Our goal was to determine whether the pattern of presyncopal prodromal
symptoms can predict the recurrence probability of vasovagal syncope.
Methods: Seventy-nine consecutive patients (male/female: 53/26) with history of VVS and
positive tilt table test (TTT) were enrolled in the study and completed the follow-up time for one
year. They all had normal electrocardiograms and cardiac echocardiography without underlying
disease. All of them were evaluated meticulously for prodromal symptoms (diaphoresis,
nausea, palpitation and blurred vision) and frequency of syncopal spells in their past medical
history. They received metoprolol at maximum tolerated dose and were taught tilt training as
an empirical therapy after TTT.
Results: Fifty-four patients (68.4%) reported at least one of the four main prodromal symptoms.
Median syncopal ± presyncopal spells were 4 episodes. Forty-two patients (53.2%)
experienced recurrence of syncope or presyncope during the follow-up period. In recurrent
symptomatic patients, diaphoresis had been more significantly reported in their past medical
history (p = 0.018) and they had more syncopal spells before TTT (p = 0.001). Age, gender
and type of TTT response did not have any effect on the recurrence of VVS.
Conclusions: Patients with a history of diaphoresis as a prodromal symptom and more pretilt
syncopal attacks experience more syncopal or presyncopal spells during follow-up
