RT Journal Article
SR Electronic
T1 Malignant vasovagal syncope: a randomised trial of metoprolol and clonidine.
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 268
OP 272
DO 10.1136/hrt.77.3.268
VO 77
IS 3
A1 Biffi, M.
A1 Boriani, G.
A1 Sabbatani, P.
A1 Bronzetti, G.
A1 Frabetti, L.
A1 Zannoli, R.
A1 Branzi, A.
A1 Magnani, B.
YR 1997
UL http://heart.bmj.com/content/77/3/268.abstract
AB OBJECTIVE: To evaluate the efficacy of head up tilt guided treatment with metoprolol and clonidine in preventing the recurrence of syncope in patients with malignant vasovagal syncope. PATIENTS: 20 patients (9 men and 11 women, mean age 33 (SD 17), range 14 to 62 years) with severe symptoms. DESIGN: Randomised double blind crossover trial; efficacy was assessed by head up tilt testing. RESULTS: Metoprolol was more effective than clonidine in abolishing syncope (19/20 v 1/20, P < 0.001) but clonidine showed some beneficial effects on time to syncope and severity of hypotension in 12 patients. During an average follow up of 15 (3) months there was a significant reduction in the recurrence of symptoms compared with the previous year in patients who had tilt up guided treatment (18 metoprolol, 1 clonidine). CONCLUSIONS: Treatment guided by head up tilting is a reliable method of treating patients with malignant vasovagal syndrome. Metoprolol was an effective long term treatment for preventing syncope. High doses were more effective and a careful dose titration period helped to minimise withdrawal symptoms and side effects.