Neurocardiogenic syncope is the major type of syncope and beta-blocker is initial drug of choice. However, the data generated from the studies so far could not represent the beneficial effects of beta-blocker, and the recurrence rate in the long term was not established. This study examined the long-term follow-up on patients with neurocardiogenic syncope with or without therapy and campared among the therapeutic strategies in preventing the relapse of syncope.

Among the 197 patients with neurocardiogenic syncope or presyncope, who underwent head-up tilt test (HUT) from Oct. 1994 to Sep. 1996, we investigated 125 patients (59 males and 66 females). They were either interviewed on the phone or answered the questionnaire. The mean age was 3916 years old and the mean duration of follow-up was 195.9 months.

Out of the 125 patients, 85 patients (68%) turned out to be HUT-positive and 40 patients (32%), negative. In the course of the follow-up on the HUT-positive patients, the symptoms recurred in 2 (10%) of the 20 patients who continued medication, 4 (25%) of the 16 patients who had no medication, and 11 (22.4%) of the 49 patients who discontinued medication on the way. Out of the 20 HUT-positive patients who continued medication, the symptom recurred in 1 (7.1%) of the 14 patients who received head-up tilt guided therapy, and 1 (16.1%) of the 6 patients in empirical therapy group.

The outcome of the group who had gone through the long-term treatment of neurocardiogenic syncope, was found to be more favorable than the one of no therapy group, and this implies that the tilt-guided therapy may be more effective than the empirical therapy in order to prevent neurocardiogenic syncope. However, there would be more radomized, placebo-controlled and larger scale research to be desired at this point.