Response to treatment during medium-term follow-up in a series of patients with neurocardiogenic syncope.
BACKGROUND
Syncope is a common symptom that has different recurrence ratios. We hypothesized that an individualized treatment regimen including pharmacologic and nonpharmacologic measures considering kind of neurocardiogenic syncope (NCS) and basal characteristics of each patient could allow optimized therapy to avoid recurrences.


METHODS
We conducted a prospective study to evaluate performance of diverse accepted treatments for NCS. Each patient received specific treatment including general measures such as an increase in salt and water intake, tilt training, specific pharmacologic treatment according to head-up tilt table test (HUTT) result, and patient basal blood pressure and heart rate measurements.


RESULTS
We followed a group of 127 patients during a main period of 20.8 +/- 9 months (range, 6-38 months). Mean age was 47.8 +/- 19.2 years and 66.9% were females. We had six (4.7%) patients with recurrence of symptoms 4 +/- 0.9 months after diagnostic HUTT. Medications used were atenolol in 20 patients, pindolol in 17, dysopiramide in 50, and fluoxetine in 25. Two patients received fludrocortisone. Tilt training was not indicated initially for patients with recurrences but was indicated later; to date, these patients have not experienced further episodes.


CONCLUSIONS
Increase in water and salt intake, as well as tilt training, showed great value in prevention of syncope recurrences in this specific set of patients. Pharmacologic treatment has an important role, but there is no single medication associated with significant improvement in symptom control.
Lafuente
Enrique Asensio
EA
Departamento de Cardiología, Clínica de Marcapasos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México. easensio@avantel.net
Martínez
Lilia Castillo
LC
Moguel
Jorge Oseguera
JO
David
René Narváez
RN
García
Joel Dorantes
JD
Tejeda
Arturo Orea
AO
Reyes
Pablo Hernández
PH
González
Verónica Rebollar
VR
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001262:Atenolol / Q000627:therapeutic use; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010869:Pindolol / Q000627:therapeutic use; D011446:Prospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D019462:Syncope, Vasovagal / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D018667:Tilt-Table Test; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D001262:Atenolol; D005473:Fluoxetine; D010869:Pindolol; D017367:Selective Serotonin Reuptake Inhibitors