Vasovagal syncope (VVS) is the transitory loss of consciousness secondary to generalized cerebral hypoperfusion due to arterial hypotension with or without a concomitant reduction of heart rate [1]. Subjects suffering from recurrent VVS can have a high psychological stress including anxiety, depression, concern, and somatic complaints [2, 3]. In previous studies, syncopal burden has been inversely correlated with quality of life but no significant correlation was observed between anxiety, depression and the patient's syncopal burden [2, 3]. The aim of this study was to correlate syncopal burden with symptoms score of anxiety and depression in subjects with VVS and no psychiatric disorders.

The study included 51 patients (27 females, median age 17 years, age range 15 to 45 years old) attending a syncope unit. All patients were evaluated by an expert physician. Diagnosis was established in the presence of a clinical history characteristic of VVS (simple fainting of very brief duration that occurs with the subject standing or at the moment of stand-up) with one or more of the following prodromal symptoms: dizziness, pallor, visual blurring, diaphoresis, dysesthesia, sighing dyspnea, tremor in fingers, or nausea [4, 5]. All participants filled out the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI) and a cognitive function test [6–8]. Syncopal burden was classified as follows: low burden (≤ 3 events in the last 6 months), high syncopal burden (N3 events). No significant differences were observed in cognitive function and educational grade among subjects with high or low syncopal burden (data not shown). Exclusion criteria were: orthostatic hypotension, suspected or confirmed heart disease, other specific causes of neurally mediated syncope (situational or associated to coughing, swallowing or brisk neck movements), metabolic or neurological disorders, any concurrent disease or treatment that affects the autonomic nervous system, or known psychiatric disorder. All subjects gave informed written consent to participate. The study complies with the ethical guidelines of the 1975 Declaration of Helsinki, as well as the standards established by the Ethics Committee of the Instituto Nacional de Cardiologia Ignacio Chavez. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology.