Midodrine for the Prevention of Vasovagal Syncope

Sheldon, Robert S.; Faris, Peter; Tang, Anthony; Ayala‐Paredes, Felix; Guzmán, Juan C.; Márquez, Manlio F.; Morillo, Carlos A.; Krahn, Andrew D.; Kús, Teresa; Ritchie, Debbie; Safdar, Shahana; Maxey, Connor; Raj, Satish R.; Investigators, Post

doi:10.7326/m20-5415

Cited by 44 publications

(28 citation statements)

References 37 publications

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“…Hence, children with VVS or POTS have received salt, water, beta-blockers, or midodrine as treatments. Occasionally, octreotide or pyridostigmine have been used to treat POTS patients, albeit with varying efficacies [ 22 , 23 , 24 , 25 , 26 ]. Considering their different mechanisms and the poor results of current treatments, scientists have sought improvements using individualized treatments.…”

Section: Individualized Therapymentioning

confidence: 99%

“…β-blockers reduce the recurrence of syncope by reducing the stimulation of the baroreceptors [ 75 ]. However, the effects of treatment vary [ 26 , 109 , 110 ]. Measuring the baroreflex sensitivity (BRS) enables the evaluation of baroreceptor responses to alterations in blood pressure and reflects the influence of vagus nerve activity on the heart.…”

Section: Individualized Therapymentioning

confidence: 99%

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Biomarkers and Hemodynamic Parameters in the Diagnosis and Treatment of Children with Postural Tachycardia Syndrome and Vasovagal Syncope

Cheng

Wang

Lin

2022

IJERPH

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In children, vasovagal syncope and postural tachycardia syndrome constitute the major types of orthostatic intolerance. The clinical characteristics of postural tachycardia syndrome and vasovagal syncope are similar but their treatments differ. Therefore, their differential diagnosis is important to guide the correct treatment. Therapeutic methods vary in patients with the same diagnosis because of different pathomechanisms. Hence, in patients with vasovagal syncope or postural tachycardia syndrome, routine treatments have an unsatisfactory efficacy. However, biomarkers could increase the therapeutic efficacy significantly, allowing for an accurate and detailed assessment of patients and leading to improved therapeutic effects. In the present review, we aimed to summarize the current state of research into biomarkers for distinguishing the diagnosis of pediatric vasovagal syncope from that of postural tachycardia syndrome. We also discuss the biomarkers that predict treatment outcomes during personalized therapy for each subtype.

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Section: Individualized Therapymentioning

confidence: 99%

Section: Individualized Therapymentioning

confidence: 99%

Biomarkers and Hemodynamic Parameters in the Diagnosis and Treatment of Children with Postural Tachycardia Syndrome and Vasovagal Syncope

Cheng

Wang

Lin

2022

IJERPH

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“…Midodrine increases BP in patients with constitutional hypotension [63] and has demonstrated positive effects on symptoms due to neurogenic orthostatic hypotension and recurrent reflex syncope [36,64,65]. The recent Prevention of Syncope Trial (POST) 4 [66] re-emphasizes the value of midodrine in reflex syncope. The trial involved patients with severely symptomatic reflex syncope and showed a 40% relative risk reduction of recurrence using c.10 mg 3/day compared with placebo; adverse events were modest and balanced in the two study groups.…”

Section: Pharmacological Therapiesmentioning

confidence: 99%

Syncope: new solutions for an old problem

et al. 2021

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“…3,4 VVS is a benign condition usually not associated with increased cardiovascular risk 4 ; however, frequently recurring VVS can lead to significant reductions in quality of life, a higher risk of depression and anxiety, impairment of daily activities, put patients at risk of physical injuries, and impose a financial burden on the healthcare system. [5][6][7] Even with treatment, many patients are still at risk for recurrent episodes, 8,9 thus investigation of new therapeutic approaches to further mitigate the burden of syncope is important.…”

Section: Introductionmentioning

confidence: 99%

Implementation of supervised physical training to reduce vasovagal syncope recurrence: A randomized controlled trial

Aghajani

Tavolinejad

Sadeghian

et al. 2022

Cardiovasc electrophysiol

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Introduction: Physical techniques used for the prevention of vasovagal syncope have limited evidence for efficacy. We aimed to evaluate multimodal supervised physical training as a treatment approach. Methods: In this 1:1 randomized trial, patients with ≥2 episodes of clinically diagnosed vasovagal syncope were included. On top of standard care, the intervention arm performed supervised tilt training and aerobic exercise in six sessions at a cardiac rehabilitation center (three sessions during the first month, and then at 3-month intervals), plus home tilt training. The control arm received standard care with a similar protocol of home tilt training. The primary outcome was time to first syncopal recurrence during 1 year of follow-up.Results: Fifty participants were randomized (mean age: 34.5 ± 14.8 years; 64% female). The rate of syncopal recurrence was 28% and 64% within the intervention and control arms, respectively, with significantly higher syncope-free survival at 1 year in the intervention arm (Log-rank p = .003). The frequency of recurrent syncopal events was significantly lower with physical training (p = .017). Participants in the intervention arm reported significantly higher adherence to the home tilt training program (80% vs. 52%; p = .037).Conclusion: Among patients with recurrent vasovagal syncope, a supervised program of tilt training and aerobic exercise reduced syncopal recurrence. Future trials are warranted to further investigate multimodal supervised physical techniques as a therapeutic approach in treating vasovagal syncope.

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Midodrine for the Prevention of Vasovagal Syncope

Cited by 44 publications

References 37 publications

Biomarkers and Hemodynamic Parameters in the Diagnosis and Treatment of Children with Postural Tachycardia Syndrome and Vasovagal Syncope

Biomarkers and Hemodynamic Parameters in the Diagnosis and Treatment of Children with Postural Tachycardia Syndrome and Vasovagal Syncope

Syncope: new solutions for an old problem

Implementation of supervised physical training to reduce vasovagal syncope recurrence: A randomized controlled trial

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