Fatigue is significant in vasovagal syncope and is associated with autonomic symptoms

Aims To quantify the prevalence of fatigue and its severity in vasovagal syncope (VVS) and to examine whether fatigue severity associates with symptoms of autonomic dysfunction. Methods and results All vasovagal syncope patients diagnosed between September 2004 and March 2006 were included (n = 140). Fatigue was quantified using the fatigue impact scale (FIS) and severity and type of autonomic symptoms by the composite autonomic symptom scale (COMPASS). Patients were considered a 'responders' if they were no longer experiencing VVS symptoms or 'non-responders' if VVS symptoms were on-going. The VVS cohort was matched, in terms of both age and sex, with a group of community dwelling controls. Ninety-six VVS patients completed questionnaires (response rate 96/ 140, 69%). Compared with matched controls, VVS patients were significantly more fatigued (26 +/- 32 vs. 13 +/- 14, P < 0.0001) and a significantly higher autonomic symptom burden (COMPASS total score: 34 +/- 23 vs. 13 +/- 13; P < 0.0001). Significant correlations were seen between the total COMPASS score and fatigue severity (r(2) = 0.4; P < 0.0001). Non-responders reported significantly higher fatigue and more autonomic symptoms than responders to treatment (P < 0.0001). Conclusion Fatigue is a significant problem experienced by patients with VVS and is associated with autonomic symptoms, the severity of which correlates with fatigue severity. These symptoms are especially profound in those who have not responded to treatment.