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STATE-OF-THE-ART PAPER

Vasovagal Syncope in the Older Patient

Maw Pin Tan, BMedSci, BMBS, MRCP^_*,1 and Steve W. Parry, MBBS, PhD, FRCP^_*,,_*

^_* Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, United Kingdom
Falls and Syncope Service, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.

Manuscript received May 16, 2007; revised manuscript received November 8, 2007, accepted November 12, 2007.

^_* Reprint requests and correspondence: Dr. Steve W. Parry, Falls and Syncope Service, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, United Kingdom. (Email: steve.parry{at}nuth.nhs.uk).

Vasovagal syncope (VVS) has been diagnosed with increasing frequency in older patients since the head-up tilt-table test (HUT) was described over 2 decades ago. The incidence and prevalence of VVS in this age group remains unknown. Older individuals are more likely to display a dysautonomic hemodynamic pattern with a predominantly hypotensive response during HUT. The positivity rates to passive and isoprotenerol-provoked HUT are reduced with age, but positivity rates for glyceryl-trinitrate-induced HUT are comparable with younger subjects. Few studies into treatment strategies have included older subjects. This is a review of the existing literature on the epidemiology, clinical characteristics, diagnostic tools, and treatment strategies for VVS in older patients, highlighting important areas for future research.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   ATP = adenosine triphosphate   GTN = glyceryl trinitrate   HF-HRV = high-frequency-heart rate variability   HUT = head-up tilt-table test(ing)   VVS = vasovagal syncope

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