903 A randomized clinical trial of fludrocortisone for the prevention of vasovagal syncope (POST2)

Sheldon, Robert S.; Morillo, Carlos A.; Krahn, A.; Medina, E.; Talajic, Mario; Kús, Teresa; Lelonek, M.; Ritchie, Debbie; McRae, Marc P.; Rose, Suzanne

doi:10.1016/j.cjca.2011.07.614

Cited by 11 publications

(6 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[11][12][13] In older patients, the use of beta-blockers, vasopressors and mineralocorticoids have been well studied, but their efficacy may be limited, with conflicting results as to whether they have long-term benefits in preventing loss of consciousness episodes. 11,[14][15][16][17] Prior studies have shown the effectiveness of pacing infants and young children with significant breath-holding spells. 6,18 Transvenous devices for these patients appear to be more common in the literature (63%) compared to our cohort, which is understandable given the more invasive nature of epicardial systems and higher predilection for lead fracture.…”

Section: Discussionmentioning

confidence: 99%

Pacemaker use for the treatment of reflex-mediated syncope: 40-year experience at a single paediatric institution

et al. 2021

View full text Add to dashboard Cite

Introduction: Reflex-mediated syncope occurs in 15% of children and young adults. In rare instances, pacemakers are required to treat syncopal episodes associated with transient sinus pauses or atrioventricular block. This study describes a single centre experience in the use of permanent pacemakers to treat syncope in children and young adults. Materials and methods: Patients with significant pre-syncope or syncope and pacemaker implantation from 1978 to 2018 were reviewed. Data collected included the age of presentation, method of diagnosis, underlying rhythm disturbance, age at implant, type of pacemaker implanted, procedural complications and subsequent symptoms. Results: Fifty patients were identified. Median age at time of the first syncopal episode was 10.2 (range 0.3–20.4) years, with a median implant age of 14.9 (0.9–34.3) years. Significant sinus bradycardia/pauses were the predominant reason for pacemaker implant (54%), followed by high-grade atrioventricular block (30%). Four (8%) patients had both sinus pauses and atrioventricular block documented. The majority of patients had dual-chamber pacemakers implanted (58%), followed by ventricular pacemakers (38%). Median follow-up was 6.7 (0.4–33.0) years. Post-implant, 4 (8%) patients continued to have syncope, 7 (14%) had complete resolution of their symptoms, and the remaining reported a decrease in their pre-syncopal episodes and no further syncope. Twelve (24%) patients had complications, including two infections and eight lead malfunctions. Conclusions: Paediatric patients with reflex-mediated syncope can be treated with pacing. Complication rates are high (24%); as such, permanent pacemakers should be reserved only for those in whom asystole from sinus pauses or atrioventricular block has been well documented.

show abstract

Section: Discussionmentioning

confidence: 99%

Pacemaker use for the treatment of reflex-mediated syncope: 40-year experience at a single paediatric institution

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In patients with orthostatic hypotension or reflex syncope with dominant vasodepressor, component drugs which increase intravascular fluid volume such as fludrocortisone or agents which increase peripheral vascular resistance via alpha receptor activation such as midodrine can be helpful. However, their efficacy is limited and reaches 58% in the case of midodrine6 and 56% when fludrocortisone is used 7. Beta blockers have been proposed by the US guidelines8 in those <42 years of age; however, European guidelines did not back up this recommendation 1.…”

Section: Treatmentmentioning

confidence: 99%

Reflex syncope: assessment and management

Kułakowski

2023

Heart

View full text Add to dashboard Cite

“…There was a trend toward benefit with a relative risk reduction of 26% (P=0.066). (Sheldon et al., 2011) Likely due to blood pressure constraints, the average age of the subjects skewed toward the young, with a mean age of 30 years and a maximum age of 46 years. Given this trend toward significance, we continue to utilize fludrocortisone in younger VVS patients.…”

Section: Pharmacological Treatment Of Vvsmentioning

confidence: 99%

Non-invasive management of vasovagal syncope

Coffin¹,

Raj²

2014

Autonomic Neuroscience

View full text Add to dashboard Cite

Vasovagal syncope (VVS) is a common disorder of the autonomic nervous system. While recurrent syncope can cause very impaired quality of life, the spells are not generally life-threatening. Both non-pharmacological and pharmacological approaches can be used to treat patients. Conservative management with education, exercise and physical maneuvers, and aggressive volume repletion is adequate for controlling symptoms in most patients. Unfortunately, a minority of patients will continue to have recurrent syncope despite conservative therapy, and they may require medications. These could include vasopressor agents, beta-blockers, or neurohormonal agents. Some patients may require more aggressive device based therapy with pacemakers or radiofrequency ablation, which are emerging therapies for VVS. This paper will review non-procedure based treatments for VVS.

show abstract

903 A randomized clinical trial of fludrocortisone for the prevention of vasovagal syncope (POST2)

Cited by 11 publications

References 0 publications

Pacemaker use for the treatment of reflex-mediated syncope: 40-year experience at a single paediatric institution

Pacemaker use for the treatment of reflex-mediated syncope: 40-year experience at a single paediatric institution

Reflex syncope: assessment and management

Non-invasive management of vasovagal syncope

Contact Info

Product

Resources

About