Predição de duração de tratamento e recorrência em pacientes portadores de síncope vasovagal: há luz no fim do túnel?

. Despite a signifi cant effort in clinical research the sad reality is that we are still looking for appropriate therapeutic measures. By in large most patients are reassured by the result of tilt table testing clearly reproducing the symptoms that have been frequently neglected or misinterpreted by one or usually more physicians. These patients do fairly well by simply increasing water and sodium ingestion as well as being trained to identify prodromal symptoms early and intervening with physiologic maneuvers that are easy to implement. However, those of us that care for these patients are well aware of the significant proportion of patients that require one or a combination of pharmacological therapies. Given the fact that most of these patients are young and highly functional several questions are usually raised by these patients; how long should I take these medications, will I have this happen again, is this “disease” life-threatening?Clinical research has provided some of these answers however the jury is still deliberating particularly regarding the issue of therapy discontinuation. In order to defi ne how to appropriately manage these patients a number of issues need to be considered. First; how symptomatic was the patient prior to initiating pharmacological therapy?Second; can we predict the recurrence rate in patients with VVS?Third; is tilt table testing useful in identifying chronic recurrent VVS?The answer to these questions is indeed clinically relevant and of prime importance for the patient. There is little doubt that VVS markedly disrupts patient’s lives and undermine quality of life. However, how frequent it is really a problem is an issue that remains to be addressed. It is reasonable to assume that patients with at least 3 yearly episodes are highly symptomatic and merit therapy. This is of course a highly subjective matter and little evidence is available to support this practice. At any rate some clinical decisions need to be taken simply based on experience and not necessarily guided by evidence particularly when there is no evidence available.Can we predict the recurrence rate of patients with VVS? Sheldon et al have elegantly identifi ed that patients with more than 6 lifetime syncopal episodes have a strikingly high recurrence rate of 72% and 60% at 1 and 2 years respectively

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