A controlled trial of acute and long-term medical therapy in tilt-induced neurally mediated syncope.
To study the efficacy of medical treatment for preventing syncopal recurrences in patients affected by tilt-induced neurally mediated syncope, a randomized placebo-treatment prospective study was performed in 30 patients (10 men and 20 women, mean age 42 +/- 21 years) who had syncope reproduced in 2 consecutive head-up tilt-table tests without pharmacologic intervention (n = 20) or during isoproterenol infusion (n = 10). Patients were randomly assigned to 2 groups: 15 to placebo, and 15 to drug therapy (determined on the basis of serial pharmacologic tilting tests). Therapy was either atenolol (n = 7), dihydroergotamine (n = 2), domperidone (n = 2), cafedrine (n = 1), or elastic compression stockings, alone or in association with drugs (n = 3). During a mean of 10 +/- 7 months of follow-up, syncope recurred in 3 patients (20%) in the treatment group and in 4 (27%) in the placebo group; actuarial rates of absence of syncopal recurrences after 20 months were 70 and 67%, respectively. Thus, the outcome of either treated or untreated patients was favorable (with a low recurrence rate of syncope), and the usefulness of tilting-guided medical therapy remains uncertain.
Brignole
M
M
Laboratory of Clinical Electrophysiology and Pacing, Ospedali Riuniti, Lavagna, Italy.
Menozzi
C
C
Gianfranchi
L
L
Lolli
G
G
Bottoni
N
N
Oddone
D
D
D000328:Adult; D001262:Atenolol / Q000627:therapeutic use; D001458:Bandages; D004087:Dihydroergotamine / Q000627:therapeutic use; D004294:Domperidone / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007545:Isoproterenol / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010665:Phenylpropanolamine / Q000031:analogs & derivatives / Q000627:therapeutic use; D011187:Posture; D011446:Prospective Studies; D012008:Recurrence; D013575:Syncope / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D013806:Theophylline / Q000031:analogs & derivatives / Q000627:therapeutic use
C002749:cafedrine; D010665:Phenylpropanolamine; D004087:Dihydroergotamine; D001262:Atenolol; D004294:Domperidone; D013806:Theophylline; D007545:Isoproterenol