Long-Term Effects of Pharmacological Therapy for Vasovagal Syncope on the Basis of Reproducibility During Head-Up Tilt Testing

Nakagawa, Haruyuki; Kobayashi, Youichi; Kikushima, Shuji; Shinohara, Makoto; Obara, Chiaki; Zinbo, Yoshihiro; Chiyoda, Kazumi; Miyata, Akira; Tanno, Kaoru; Baba, Takao; Kubo, Takashi

doi:10.1253/jcj.62.727

Cited by 12 publications

(4 citation statements)

References 28 publications

(78 reference statements)

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“…A possible confounding factor influencing the outcome of the repeated tests might be habituation. However, previous studies reported that immediate reproducibility of orthostatic tests (within about 30 minutes from the first test) was 87 % by Chen [8], 82 % by Morillo [16], 91 % by Nakagawa [18]. Repeated orthostatic tests hardly cause habituation.…”

Section: ■ Limitation Of the Studymentioning

confidence: 87%

Comparison of the active standing test and head-up tilt test for diagnosis of syncope in childhood and adolescence

Matsushima¹,

Tanaka

Tamai

2004

Clin Auton Res

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We examined 51 children and adolescents with orthostatic symptoms using two orthostatic tests, the active standing test (the AS test) and head-up tilt test (HUT), and compared circulatory responses, autonomic function in addition to the induction rate of syncope during short-time orthostasis. Syncope was induced in eight patients with both tests, in only six patients with the AS test and in only one patient with HUT. The induction rate was significantly higher with the AS test (p<0.0001). In addition, the AS test is common and daily postural motion and does not require a tilt table. We calculated percent changes in systolic blood pressure at the initial drop (DeltaID-SBP), in systolic blood pressure (DeltaSBP), in diastolic blood pressure (DeltaDBP), in heart rate (DeltaHR), component coefficient variation LF/HF (DeltaLF/HF) from supine to upright. DeltaHR were significantly larger in fainters than in non-fainters with both tests, although there was no difference in DeltaSBP and in DeltaDBP. In six fainters only with the AS test, DeltaHR was significantly larger with the AS test than with HUT. With the AS test DeltaID-SBP were correlative with DeltaLF/HF, and DeltaLF/HF were correlative with DeltaHR, whereas these relations were not clear in HUT. These results indicated the AS test caused cardiac sympathetic activation associated with an initial pressure drop, and was more prone to induce syncope with a greater HR increase in some patients. We conclude the AS test is as potential as HUT as a diagnostic test for syncope.

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Section: ■ Limitation Of the Studymentioning

confidence: 87%

Comparison of the active standing test and head-up tilt test for diagnosis of syncope in childhood and adolescence

Matsushima¹,

Tanaka

Tamai

2004

Clin Auton Res

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“…Studies were then excluded if they were based on evaluation of pacemaker implantation for vasovagal syncope, did not include a comparison arm, or did not investigate therapies for vasovagal syncope. A total of 18 studies were included in the final analysis [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] (Figure 1). All studies were randomized with 4 studies also having a crossover component (Table 1).…”

Section: Manuscript Identification and Characteristicsmentioning

confidence: 99%

Medical Management of Vasovagal Syncope: A Network Meta Analysis

Loomba¹,

Nijhawan²,

Aggarwal³

et al. 2017

Cardiol Cardiovascmed

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Introduction: Multiple pharmacologic therapies have been studied to prevent recurrence in patients with vasovagal syncope. Multiple head to head comparisons have been done with varying results. We aimed to perform a network meta-analysis to assess the efficacy of pharmacologic therapies in preventing recurrent syncope in patients with vasovagal syncope. Methods: A systematic review of the literature was performed to identify randomized controlled trials describing recurrence of vasovagal syncope after initiation of pharmacologic treatment in patients with syncope who had a baseline positive tilt table test. A Bayesian network meta-analysis was conducted utilizing the geMTC package available for R: A Language and Environment for Statistical Computing.Results: None of the included pharmacological therapies were found to significantly reduce the recurrence of vasovagal syncope when compared to placebo. When compared to one another atenolol did offer significant reduction in syncopal episodes when compared to cafedrine. Dihydroergotamine ranked the highest while cafedrine ranked the lowest.Conclusions: Pharmacologic therapies do not offer significant reduction in recurrence of vasovagal syncope. First line therapy for these patients should include lifestyle changes such as increased fluid intake, and when appropriate, increased salt intake.

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“…The tilting was performed for 15 min or until development of presyncope or syncope. 4 Blood pressure and electrocardiogram monitoring were performed continuously. If no presyncope or syncope appeared, the patient was lowered to the supine position and then continuous intravenous isoproterenol infusion 5,6 was started at 0.01 g kg -1 min -1 .…”

Section: Protocol Of Hutmentioning

confidence: 99%