Are treatments for vasovagal syncope effective? A meta-analysis

Ankur Vyas; Paari Dominic Swaminathan; Miriam B Zimmerman; Brian Olshansky

doi:10.1016/j.ijcard.2012.04.144

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Are treatments for vasovagal syncope effective? A meta-analysis

Journal article

Peer reviewed

Are treatments for vasovagal syncope effective? A meta-analysis

Ankur Vyas, Paari Dominic Swaminathan, Miriam B Zimmerman and Brian Olshansky

International journal of cardiology, Vol.167(5), pp.1906-1911

09/01/2013

DOI: 10.1016/j.ijcard.2012.04.144

PMID: 22626839

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Abstract

Therapies used to treat vaso-vagal syncope (VVS) recurrence have not been proven effective in single studies. Comprehensive search of PubMed, EMBASE and Cochrane Central databases of published trials was done. Randomized or non-randomized studies, comparing the intervention of interest to control group(s), with the endpoint of spontaneous recurrence or syncope on head-up tilt test, were included. Data were extracted on an intention-to-treat basis. Study heterogeneity was analyzed by Cochran's Q statistics. A random-effect analysis was used. α-adrenergic agonists were found effective (n=400, OR 0.19, CI 0.06–0.62, p<0.05) in preventing VVS recurrence. β-blockers were not found to be effective when only randomized studies comparing β-blockers to non-pharmacologic agents were assessed (9 studies, n=583, OR 0.48, CI 0.22–1.04, p=0.06). Tilt-training had no effect when only randomized studies were considered (4 studies, n=298, OR 0.47, CI 0.21–1.05, p=0.07). Selective serotonin reuptake inhibitors were found effective (n=131, OR 0.28, CI 0.10–0.74, p<0.05), though the analysis contained only 2 studies. Pacemakers were found effective in preventing syncope recurrence when all studies were analyzed (n=463, OR 0.13, CI 0.05–0.36, p<0.05). However, studies comparing active pacemaker to sensing mode only did not show benefit (3 studies, n=162, OR 0.45, CI 0.09–2.14, p=0.32). This meta-analysis highlights the totality of evidence for commonly used medications used to treat VVS, and the requirement for larger, double-blind, placebo controlled trials with longer follow-up.

Alpha-adrenergic agonists

Vaso‐vagal syncope

Syncope

Neurocardiogenic syncope

Beta-adrenergic blockers

Tilt training

Details

Title: Subtitle: Are treatments for vasovagal syncope effective? A meta-analysis
Creators: Ankur Vyas - Department of Internal Medicine, University of Iowa Hospitals and Clinics, United States
Paari Dominic Swaminathan - Department of Internal Medicine, University of Iowa Hospitals and Clinics, United States
Miriam B Zimmerman - School of Public Health, University of Iowa, United States
Brian Olshansky - Department of Internal Medicine, University of Iowa Hospitals and Clinics, United States
Resource Type: Journal article
Publication Details: International journal of cardiology, Vol.167(5), pp.1906-1911
DOI: 10.1016/j.ijcard.2012.04.144
PMID: 22626839
NLM abbreviation: Int J Cardiol
ISSN: 0167-5273
eISSN: 1874-1754
Publisher: Elsevier Ireland Ltd
Language: English
Date published: 09/01/2013
Academic Unit: Biostatistics; Cardiovascular Medicine; Internal Medicine
Record Identifier: 9983997327902771

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