The Use of Serotonin Reuptake Inhibitors for the Treatment of Recurrent Syncope Due to Carotid Sinus Hypersensitivity Unresponsive to Dual Chamber Cardiac Pacing

Grubb, Blair P.; Samoil, Daniela; KOSINSKl, Daniel; Temesy‐Armos, Peter; Akpunonu, Basil E.

doi:10.1111/j.1540-8159.1994.tb02463.x

Cited by 36 publications

(14 citation statements)

References 11 publications

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“…For the most part, dualchamber cardiac pacing is preferred (level B) [306][307][308] , although it has been argued that single-chamber ventricular pacing may be sufficient in those relatively infrequent cases in which there is absence of both a marked vasodepressor component to the hypotension and so-called 'ventricular pacing effect' [71] . Medical therapy for carotid sinus syndrome has largely been abandoned [310,311] . There are as yet no randomized studies examining treatment of carotid sinus syncope in which hypotension is predominantly of vasodepressor origin.…”

Section: Carotid Sinus Syndromementioning

confidence: 99%

Guidelines on management (diagnosis and treatment) of syncope

Brignole¹,

Alboni²,

Benditt

et al. 2001

European Heart Journal

677

432

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Section: Carotid Sinus Syndromementioning

confidence: 99%

Guidelines on management (diagnosis and treatment) of syncope

Brignole¹,

Alboni²,

Benditt

et al. 2001

European Heart Journal

677

432

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“…17 Accordingly, the role of this neurotransmitter in cardiovascular disorders that involve neurally mediated hypotension and bradycardia has received great interest. In particular, SSRIs have been used as a therapy in chronic orthostatic hypotension, 6 carotid sinus hypersensitivity, 7,18 and NMS. 19 Grubb et al 6 evaluated the usefulness of fluoxetine hydrochloride, a selective SSRI, in 16 patients with recurrent syncope and a positive tilt-table test.…”

Section: Previous Animal Studiesmentioning

confidence: 99%

“…On the basis of these animal studies, several investigators have examined the usefulness of serotonin reuptake inhibitors as a therapy for neurally mediated cardiovascular disorders. [5][6][7]16 The Role of SSRIs in Neurally Mediated Cardiovascular Disorders…”

Section: Previous Animal Studiesmentioning

confidence: 99%

“…[5][6][7] Recently, Girolamo et al 5 demonstrated the effectiveness of paroxetine hydrochloride (Paxil, SmithKline Beecham) in reducing tilt and recurrent syncope in patients with refractory NMS. The postulated mechanism of action is an increase in central serotonin levels, which results in down-regulation of serotonin receptors, and thus attenuates any short-term, sudden shifts in central serotonin levels.…”

mentioning

confidence: 99%

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Serotonin Reuptake Inhibitor (Paxil) Does Not Prevent the Vasovagal Reaction Associated With Carotid Sinus Massage and/or Lower Body Negative Pressure in Healthy Volunteers

et al. 2002

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Background-The purpose of this study was to assess the effect of the serotonin reuptake inhibitor paroxetine hydrochloride (Paxil, SmithKline Beecham) on cardiovascular reflexes. We hypothesized that Paxil prevents neurally mediated syncope (NMS) by attenuating the sympathoinhibition and vagotonia associated with a vasovagal reaction. Methods and Results-In a double-blind randomized study, 25 healthy subjects with a positive response to either carotid sinus massage (CSM) or lower body negative pressure (LBNP) received Paxil (20 mg/d) or placebo for 6 weeks. Arterial baroreflex sensitivity (BRS), muscle sympathetic nerve activity (SNA), baroreflex control of SNA, blood pressure, and heart rate responses to CSM and LBNP were measured at baseline and at 6 weeks. Nineteen subjects completed the study (Paxil, nϭ9; placebo, nϭ10). In the Paxil group, BRS decreased significantly compared with baseline (15.8Ϯ4.0 ms/mm Hg versus 11.0Ϯ2.6 ms/mm Hg, Pϭ0.05); however, all 9 subjects continued to have a positive response to LBNP with presyncope. Paxil did not attenuate the sympathoinhibition or vagotonia associated with a positive LBNP response and had no significant effect on baroreflex control of SNA. In the control group, no significant change in BRS was noted compared with baseline. Seven out of 9 subjects who had a positive LBNP response at baseline had a repeat positive LBNP response, and the subject with a positive CSM at baseline had a negative response at 6 weeks. Conclusions-Paxil

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“…In carotid sinus syndrome, Grubb et al 40 observed apparently beneficial effects of sertraline in one case and fluoxetine in another. These observations, if confirmed, may be important because, with the possible exception of midodrine, there are as yet no other pharmacological agents to assist in treating patients with nonvasovagal neurally mediated syncope.…”

Section: Serotonin Reuptake Blockersmentioning

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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The Use of Serotonin Reuptake Inhibitors for the Treatment of Recurrent Syncope Due to Carotid Sinus Hypersensitivity Unresponsive to Dual Chamber Cardiac Pacing

Cited by 36 publications

References 11 publications

Guidelines on management (diagnosis and treatment) of syncope

Guidelines on management (diagnosis and treatment) of syncope

Serotonin Reuptake Inhibitor (Paxil) Does Not Prevent the Vasovagal Reaction Associated With Carotid Sinus Massage and/or Lower Body Negative Pressure in Healthy Volunteers

Pharmacotherapy of Neurally Mediated Syncope

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