Autonomic control of heart rate variability in vasovagal syncope: a study of the nighttime period in 24-hour recordings

Patients experiencing vasovagal syncope have been claimed to show reduced vagal tone over 24-hour electrocardiography recordings. Assessment of sympathovagal balance in the absence of external stimuli, ie, nighttime electrocardiography monitoring, might help to clarify if increased sympathetic activity is present in these patients. Heart rate variability was examined at nighttime in 40 patients with recurrent episodes of vasovagal syncope within the last 2 years (22 men; mean age, 37 years) and 20 comparable healthy volunteers. Time domain parameters (pNN50 [proportion of successive RR intervals difference > 50 ms in %] and rMSSD [root-mean-square successive difference of RR intervals in ms]), indexes of vagal tone, and frequency domain parameters, expressing the overall heart rate variability, vagal thigh frequency [HF]) and sympathetic (low frequency [LF]) activity, and autonomic balance (LF/HF ratio) were compared between groups by Mann-Whitney test. Significant (p < 0.05) reduction of heart rate variability and vagal tone (pNN50 and rMSSD) were found for patients with vasovagal syncope, together with increased sympathetic activity (increased LF/HF ratio). These findings could open new insights in the pathogenesis of vasovagal syncope because of the shift of the autonomic balance toward sympathetic activation near the syncopal episode.