title: A randomized and controlled pilot trial of beta-blockers for the treatment of recurrent syncope in patients with a positive or negative response to head-up tilt test.
abstract: The aim of this study was to assess the efficacy of lipophilic beta-blockers in preventing recurrent neurocardiogenic syncope and the value of head-up tilt test (HUT) in predicting response to therapy. The efficacy of beta-blockers in recurrent syncope is controversial. The value of HUT in predicting efficacy of therapy has not been investigated. Fifty-six patients (44+/-18 years, 36 women) with recurrent syncope (> 1 event in the last 6 months) of suspected neurocardiogenic origin were included in the study. Independent of the response to HUT, patients were randomized to receive metoprolol or propanolol at the maximal tolerated dose (28 patients, group A, 86+/-23 vs 98+/-29 mg/d) or no pharmacological therapy (28 patients, group B). The primary endpoint was the first recurrence of syncope. During the 1-year of follow-up, 20 patients of group A and 8 of group B had no recurrence. In group A, of 20 patients without recurrences 12 had a positive and 8 a negative HUT result while of 8 patients with recurrences 5 had a positive and 3 a negative response to HUT. In the group B, of 20 patients with recurrences 10 had a positive and 10 a negative HUT result while of 8 patients without recurrences 4 had a positive and 4 a negative response to HUT. In a multivariate Cox-regression analysis, medical therapy was the only independent factor for predicting recurrence of syncope (P = 0.004); HUT had no influence in this regard (P = 0.773). In conclusion, lipophilic beta-blockers appear efficacious in preventing recurrent syncope of suspected neurocardiogenic origin. The efficacy of therapy seems to be not predicted by HUT.
authors.affiliation: Department of Cardiology, University Hospital Eppendorf, Hamburg, Germany. ventura@uke.uni-hamburg.de
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Ventura
authors.forename: Renke
authors.initials: R
authors.lastname: Maas
authors.forename: Daniel
authors.initials: D
authors.lastname: Zeidler
authors.forename: Volker
authors.initials: V
authors.lastname: Schoder
authors.forename: Cristhoph A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: Andreas
authors.initials: A
authors.lastname: Schuchert
authors.forename: Thomas
authors.initials: T
authors.lastname: Meinertz
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D010865:Pilot Projects; D055502:Secondary Prevention; D019462:Syncope, Vasovagal / Q000188:drug therapy* / Q000517:prevention & control; D018667:Tilt-Table Test; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D008790:Metoprolol