Syncope pp 275-285 | Cite as

Non-Pharmacological and Pharmacological Therapies in Vasovagal Syncope: Current Status

  • Payam Pournazari
  • Satish R. RajEmail author


Vasovagal syncope (VVS) is a non-life-threatening disorder, and in most patients pharmacological treatment is not required. However, patients with recurrent episodes of syncope, and especially those suffering from prior injuries, are likely to have impaired quality of life. Drug therapies are appropriate for these patients. Despite numerous efforts and trials, therapeutic options in patients with VVS are very limited; there are no pharmacological treatments that have convincingly been shown to be effective in large clinical trials.


  1. 1.
    Von Scheidt W, Bosch R, Klingenheben T, Schuchert A, Stellbrink C, Stockburger M. Commentary on the 2018 ESC Guidelines for the diagnosis and management of syncope. Kardiologe. 2019;13(3):131–7. Scholar
  2. 2.
    Sahota I, Sheldon R, Pournazari P. Clinical improvement of vasovagal syncope in the absence of specific therapies: the Seinfeld effect. Cardiol J. 2014;21(6):637–42. Scholar
  3. 3.
    Sheldon RS, Grubb BP, Olshansky B, et al. 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural Tachycardia Syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Hear Rhythm. 2015;12(6):e41–63. Scholar
  4. 4.
    Shen W-K, Sheldon R, Benditt DG, et al. Correction to: 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. Circulation. 2017;136(5):e60–e122. Scholar
  5. 5.
    Solari D, Tesi F, Unterhuber M, et al. Stop vasodepressor drugs in reflex syncope: a randomised controlled trial. Heart. 2017;103(6):449–55. Scholar
  6. 6.
    Wiersum-Osselton J, Romeijn B, Van den Brekel E, et al. Can we prevent vasovagal reactions in young inexperienced whole blood donors? A placebo controlled study comparing effects of a 330 vs 500 mL water drink prior to donation. Transfusion. 2019;59(2):555–65. Scholar
  7. 7.
    Chu W, Wang C, Wu L, Lin P, Li F, Zou R. Oral rehydration salts: an effective choice for the treatment of children with Vasovagal syncope. Pediatr Cardiol. 2015;36(4):867–72. Scholar
  8. 8.
    Pournazari P, Sahota I, Sheldon R. High remission rates in Vasovagal syncope: systematic review and meta-analysis of observational and randomized studies. JACC Clin Electrophysiol. 2017;3(4):384–92. Scholar
  9. 9.
    van Dijk N, Quartieri F, Blanc JJ, et al. Effectiveness of physical counterpressure maneuvers in preventing vasovagal syncope. The physical counterpressure manoeuvers trial (PC-Trial). J Am Coll Cardiol. 2006;48(8):1652–7. Scholar
  10. 10.
    Tomaino M, Romeo C, Vitale E, et al. Physical counter-pressure manoeuvers in preventing syncopal recurrence in patients older than 40 years with recurrent neurally mediated syncope: A controlled study from the Third International Study on Syncope of Uncertain Etiology (ISSUE-3). Europace. 2014;16(10):1515–20. Scholar
  11. 11.
    Coffin ST, Raj SR. Non-invasive management of vasovagal syncope. Auton Neurosci Basic Clin. 2014;184:27–32. Scholar
  12. 12.
    Romme JJCM, Reitsma JB, Black CN, et al. Drugs and pacemakers for vasovagal, carotid sinus and situational syncope. Cochrane Database Syst Rev. 2011;2011(10):CD004194. Scholar
  13. 13.
    Romme JJCM, Van Dijk N, Go-Schön IK, Reitsma JB, Wieling W. Effectiveness of Midodrine treatment in patients with recurrent vasovagal syncope not responding to non-pharmacological treatment (STAND-trial). Europace. 2011;13(11):1639–47. Scholar
  14. 14.
    Izcovich A, Malla CG, Manzotti M, Catalano HN, Guyatt G. Midodrine for orthostatic hypotension and recurrent reflex syncope: a systematic review. Neurology. 2014;83(13):1170–7. Scholar
  15. 15.
    Raj SR, Faris PD, McRae M, Sheldon RS. Rationale for the prevention of syncope trial IV: assessment of midodrine. Clin Auton Res. 2012;22(6):275–80. Scholar
  16. 16.
    Sheldon R, Raj SR, Rose MS, et al. Fludrocortisone for the prevention of vasovagal syncope a randomized, placebo-controlled trial. J Am Coll Cardiol. 2016;68(1):1–9. Scholar
  17. 17.
    Brignole M, Guieu R, Tomaino M, et al. Mechanism of syncope without prodromes with normal heart and normal electrocardiogram. Hear Rhythm. 2017;14(2):234–9. Scholar
  18. 18.
    Schroeder C, Birkenfeld AL, Mayer AF, et al. Norepinephrine transporter inhibition prevents tilt-induced pre-syncope. J Am Coll Cardiol. 2006;48(3):516–22. Scholar
  19. 19.
    Sheldon RS, Ritchie D, McRae M, Raj S. Norepinephrine transport inhibition for treatment of vasovagal syncope. J Cardiovasc Electrophysiol. 2013;24(7):799–803. Scholar
  20. 20.
    Sheldon RS, Lei L, Guzman JC, et al. A proof of principle study of atomoxetine for the prevention of vasovagal syncope: the Prevention of Syncope Trial VI. Europace. 2019;21(11):1733–41. Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of MedicineUniversity of CalgaryCalgaryCanada

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