Management und Therapie der vasovagalen Synkope

Vasovagal syncope is the most common cause of recurrent syncope but although the prognosis is excellent the diagnostic and therapeutic approach is time and cost-intensive. This review focuses on the management of vasovagal syncope and discusses non-pharmacological and pharmacological treatment options, especially the use of midodrine and selective serotonin reuptake inhibitors. The early use of an implantable loop recorder is essential to exclude arrhythmia as a reason for syncope. Detailed patient information and physical counterpressure manoeuvres are the first-line treatment for patients with vasovagal syncope. The role of cardiac pacing is controversial and may be meaningful only for a subgroup of patients with severe bradycardia or asystole.