[Comparison of metoprolol vs clonazepam as a first treatment choice among patients with neurocardiogenic syncope].
OBJECTIVE
We compared the effects of a metoprolol and clonazepam in patients with neurocardiogenic syncope.


METHODS
We compared the effects of a metoprolol and clonazepam in a prospective, randomised trial in 54 patients. Patients were randomly assigned to metoprolol (starting dose 50 mg bid) or clonazepam (starting dose 0.5 mg qd). We assessed a primary combined endpoint of syncope and pre-syncope on a follow-up of 12 months.


RESULTS
The primary combined endpoint of syncope and presyncope occurred in the metoprolol group in 3, 4, and 10% of patients at 3, 6, and 12 months respectively. In the clonazepam group it was no recurrence in the first 6 months, and 5% recurrence at 12 months follow-up (nonsignificant differences between groups). Clinical symptoms commonly associated with neurally mediated syncope were decreased similarly in both treatment groups, in the metoprolol group from 5.2+/-2.5 to 1.9+/-2.1 (p < 0.001) and in the clonazepam group from 5.5+/-2.5 to 1.5+/-2.2 (p<0.001).


CONCLUSIONS
Pharmacological treatment of neurocardiogenic syncope with metoprolol or clonazepam resulted in similar prevention of syncope and presyncope. Both treatments decreased clinical symptoms but complete symptomatic resolution was rarely observed.
Márquez
Manlio F
MF
Departamento de Electrocardiología, Instituto Nacional de Cardiología Ignacio Chávez, SSA, Tlalpan, México DF, México. manliomarquez@yahoo.com
Urias-Medina
Karla
K
Gómez-Flores
Jorge
J
Sobrino
Ayax
A
Sotomayor-González
Arturo
A
González-Hermosillo
Antonio
A
Cárdenas
Manuel
M
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D002648:Child; D002998:Clonazepam / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D019462:Syncope, Vasovagal / Q000188:drug therapy*; D055815:Young Adult
D000319:Adrenergic beta-Antagonists; D002998:Clonazepam; D008790:Metoprolol