Usefulness of intravenous metoprolol to prevent syncope induced by head-up tilt

Kluger, Jeffrey; Bazunga, Munama; Goldman, Richard; O'Rangers, Eleanor A.; Azar, Peter; Chow, Moses S.S.

doi:10.1016/s0002-9149(98)00446-9

Cited by 11 publications

(3 citation statements)

References 19 publications

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“…36 In a placebo-controlled study in 31 patients, intravenous metoprolol was superior to placebo (80% and 37.5%, respectively) in preventing HUT-induced syncope. 40 Most patients in this study had positive isoproterenol-induced HUTs, therefore the benefit of ␤-blockers may be attributed to initial sympathetic stimulation. Similarly, absence of tachycardia during HUT before bradycardia occurred and was associated with a higher failure rate than when tachycardia was present.…”

Section: Investigational Therapiesmentioning

confidence: 70%

A Review of Pathophysiology and Therapy of Patients with Vasovagal Syncope

White

Tsikouris

2000

Pharmacotherapy

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Vasovagal syncope is a common disorder that can compromise quality of life and lead to significant morbidity. It is characterized by an initial exaggerated sympathetic output followed by parasympathetic activation and sympathetic withdrawal, as shown by diagnostic head-up tilt (HUT) table testing. Numerous drugs have been evaluated for treating this disorder. beta-Blockers are well studied and commonly administered but are specifically more efficacious in patients with isoproterenol HUT than in those with regular HUT. The role of the serotonergic system has captured new interest. Selective serotonin reuptake inhibitors show promising results in preventing vasovagal syncope in treatment-refractory patients. Also, new investigations suggest that serotonin receptor antagonism may be beneficial. Despite these findings, definitive treatment does not exist.

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Section: Investigational Therapiesmentioning

confidence: 70%

A Review of Pathophysiology and Therapy of Patients with Vasovagal Syncope

White

Tsikouris

2000

Pharmacotherapy

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“…Studies were then excluded if they were based on evaluation of pacemaker implantation for vasovagal syncope, did not include a comparison arm, or did not investigate therapies for vasovagal syncope. A total of 18 studies were included in the final analysis [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] (Figure 1). All studies were randomized with 4 studies also having a crossover component (Table 1).…”

Section: Manuscript Identification and Characteristicsmentioning

confidence: 99%

Medical Management of Vasovagal Syncope: A Network Meta Analysis

Loomba¹,

Nijhawan²,

Aggarwal³

et al. 2017

Cardiol Cardiovascmed

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Introduction: Multiple pharmacologic therapies have been studied to prevent recurrence in patients with vasovagal syncope. Multiple head to head comparisons have been done with varying results. We aimed to perform a network meta-analysis to assess the efficacy of pharmacologic therapies in preventing recurrent syncope in patients with vasovagal syncope. Methods: A systematic review of the literature was performed to identify randomized controlled trials describing recurrence of vasovagal syncope after initiation of pharmacologic treatment in patients with syncope who had a baseline positive tilt table test. A Bayesian network meta-analysis was conducted utilizing the geMTC package available for R: A Language and Environment for Statistical Computing.Results: None of the included pharmacological therapies were found to significantly reduce the recurrence of vasovagal syncope when compared to placebo. When compared to one another atenolol did offer significant reduction in syncopal episodes when compared to cafedrine. Dihydroergotamine ranked the highest while cafedrine ranked the lowest.Conclusions: Pharmacologic therapies do not offer significant reduction in recurrence of vasovagal syncope. First line therapy for these patients should include lifestyle changes such as increased fluid intake, and when appropriate, increased salt intake.

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“…However, the results of these studies were inconsistent and the value of this approach has not been determined yet. [5][6][7][8][9][10] The objective of the present study was to answer the question whether the results of TT performed after the intravenous administration of propranolol can identify the patients with syncope in whom a continuous beta-blocker therapy is effective.…”

mentioning

confidence: 99%