Limitations of head-up tilt test for evaluating the efficacy of therapeutic interventions in patients with vasovagal syncope: Results of a controlled study of etilefrine versus placebo

Moya, Àngel; Permanyer-Miralda, Gaietà; Sagristà-Sauleda, Jaume; Carné, Xavier; Rius, Teresa; Mont, Lluı́s; Soler‐Soler, Jordi

doi:10.1016/0735-1097(94)00336-o

Cited by 134 publications

(36 citation statements)

References 24 publications

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“…The overall reproducibility of an initial negative response (85% to 94%) is higher than the reproducibility of an initial positive response (31% to 92%). In addition, data from controlled trials showed that approximately 50% of patients with a baseline positive tilt test became negative when the test was repeated with treatment or with placebo [132][133][134] . Moreover, acute studies were not predictive of the long-term outcome of pacing therapy [135] .…”

Section: Role Of Head-up Tilt Test In Treatment Selection For Vasovagmentioning

confidence: 99%

“…In general, while the results have been satisfactory in uncontrolled trials or shortterm controlled trials [275][276][277][278][279][280][281][282][283][284][285][286][287][288] with few exceptions [132,289] , several long-term placebo-controlled prospective trials have been unable to show a benefit of the active drug over placebo [133,134,[290][291][292][293][294] with one exception [295] . In vasovagal syncope beta-blockers, owing to their negative inotropic effect, have been supposed to lessen the degree of mechanoreceptor activation associated with an abrupt fall in venous return and block the effects of elevated circulating adrenaline, but this theory has not been supported by facts.…”

Section: Vasovagal Syncopementioning

confidence: 99%

See 1 more Smart Citation

Guidelines on management (diagnosis and treatment) of syncope

Brignole¹,

Alboni²,

Benditt

et al. 2001

European Heart Journal

670

432

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Section: Role Of Head-up Tilt Test In Treatment Selection For Vasovagmentioning

confidence: 99%

Section: Vasovagal Syncopementioning

confidence: 99%

Guidelines on management (diagnosis and treatment) of syncope

Brignole¹,

Alboni²,

Benditt

et al. 2001

European Heart Journal

670

432

View full text Add to dashboard Cite

“…Reproducibility varies up to 90% depending on the response [4]. Positive responses decrease with repeated testing irrespective of assigned treatment, with approximately 50% of patients responding to placebo [22]. With respect to QOL, remarkably few studies in the Cochrane meta-analysis reported any measure: 3 of 16 beta-blocker, 2 of 8 alpha-adrenergic agonist; 1 of 2 SSRI, and 1 of 9 pacing studies [4].…”

Section: How Is Effectiveness Defined?mentioning

confidence: 99%

Does any therapy really work for neurocardiogenic syncope?

Hawkins

Krahn

2014

Cardiol J

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“…With regard to placebo control, the few available reports have usually failed to find benefit with current therapies. 24,28,42,47,64,65 To date, only atenolol has been shown to be effective in a randomized controlled trial. 25 The issue of the value of empirical treatment was addressed by Natale et al 62 …”

Section: Role Of Tilt-table Testing In Assessing Drug Therapymentioning

confidence: 99%

Pharmacotherapy of Neurally Mediated Syncope

et al. 1999

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Abstract-A wide variety of pharmacological agents are currently used for prevention of recurrent neurally mediated syncope, especially the vasovagal faint. None, however, have unequivocally proven long-term effectiveness based on adequate randomized clinical trials. At the present time, ␤-adrenergic receptor blockade, along with agents that increase central volume (eg, fludrocortisone, electrolyte-containing beverages), appear to be favored treatment options. The antiarrhythmic agent disopyramide and various serotonin reuptake blockers have also been reported to be beneficial. Finally, vasoconstrictor agents such as midodrine offer promise and remain the subject of clinical study. Ultimately, though, detailed study of the pathophysiology of these syncopal disorders and more aggressive pursuit of carefully designed placebo-controlled treatment studies are essential if pharmacological prevention of recurrent neurally mediated syncope is to be placed on a firm foundation. (Circulation. 1999;100:1242-1248.)Key Words: syncope Ⅲ nervous system Ⅲ pharmacology Ⅲ Cardiovascular Drugs N eurally mediated (neurocardiogenic) syncope comprises a number of clinical conditions in which symptomatic systemic hypotension occurs as a result of a transient disturbance of neural reflex cardiovascular control (Table 1). [1][2][3] The vasovagal faint, carotid sinus syndrome, and postmicturition syncope are the most common forms of the neurally mediated faint. Others, including cough syncope and postexertional syncope, are less frequently encountered.This communication focuses on the pharmacological options that have been proposed for preventing neurally mediated faints, and especially the vasovagal faint, because it has been the most thoroughly studied. The objective is to provide an overview of the pharmacology and pertinent proposed modes of action of those agents that may be of benefit. Drug Therapy of Neurally Mediated Syncope: Basic PrinciplesMost individuals who experience a neurally mediated faint (particularly vasovagal fainters) require no additional therapy beyond education (ie, recognition of premonitory symptoms, avoidance of triggering events, and awareness of useful evasive actions) and reassurance regarding the non-lifethreatening nature of the condition. On occasion, stress and anxiety management may be warranted. Various more aggressive nonpharmacological (eg, support hose, extended exposure to upright posture, pacemakers) and pharmacological treatment options are usually reserved for those relatively few individuals who experience frequent syncope and/or when symptoms cause excessive lifestyle difficulties, threaten employment, or result in unacceptable risk of physical injury to the patient or others.Currently, drugs are used for both diagnostic and therapeutic purposes in the patient with neurally mediated syncope. [1][2][3] In terms of diagnostic applications, agents such as isoproterenol, edrophonium, nitroglycerin, and adenosine have been reported to be helpful during tilt-table testing (ie, so-called pharmacolog...

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Limitations of head-up tilt test for evaluating the efficacy of therapeutic interventions in patients with vasovagal syncope: Results of a controlled study of etilefrine versus placebo

Cited by 134 publications

References 24 publications

Guidelines on management (diagnosis and treatment) of syncope

Guidelines on management (diagnosis and treatment) of syncope

Does any therapy really work for neurocardiogenic syncope?

Pharmacotherapy of Neurally Mediated Syncope

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