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A Randomized and Controlled Pilot Trial of β‐blockers for the Treatment of Recurrent Syncope in Patients with a Positive or Negative Response to Head‐Up Tilt Test
Author(s) -
VENTURA RODOLFO,
MAAS RENKE,
ZEIDLER DANIEL,
SCHODER VOLKER,
NIENABER CRISTHOPH A.,
SCHUCHERT ANDREAS,
MEINERTZ THOMAS
Publication year - 2002
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1046/j.1460-9592.2002.t01-1-00816.x
Subject(s) - medicine , syncope (phonology) , randomized controlled trial , metoprolol , clinical endpoint , tilt table test , heart rate , blood pressure
VENTURA, R., et al. : A Randomized and Controlled Pilot Trial of b‐Blockers for the Treatment of Recurrent Syncope in Patients with a Positive or Negative Response to Head‐Up Tilt Test. The aim of this study was to assess the efficacy of lipophilic β‐blockers in preventing recurrent neurocardiogenic syncope and the value of head‐up tilt test (HUT) in predicting response to therapy. The efficacy of β‐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 β‐blockers appear efficacious in preventing recurrent syncope of suspected neurocardiogenic origin. The efficacy of therapy seems to be not predicted by HUT.