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Malignant vasovagal syncope: a randomised trial of metoprolol and clonidine
M Biffi1, G Boriani, P Sabbatani
1Institute of Cardiology, Policlinico S Orsola, University of Bologna, Italy.
Objective:
To evaluate the efficacy of head up tilt guided treatment with metoprolol and clonidine in preventing the recurrence of syncope in patients with malignant vasovagal syncope.
Patients:
20 patients (9 men and 11 women, mean age 33 (SD 17), range 14 to 62 years) with severe symptoms.
Design:
Randomised double blind crossover trial; efficacy was assessed by head up tilt testing.
Results:
Metoprolol was more effective than clonidine in abolishing syncope (19/20 v 1/20, P < 0.001) but clonidine showed some beneficial effects on time to syncope and severity of hypotension in 12 patients. During an average follow up of 15 (3) months there was a significant reduction in the recurrence of symptoms compared with the previous year in patients who had tilt up guided treatment (18 metoprolol, 1 clonidine).
Conclusions:
Treatment guided by head up tilting is a reliable method of treating patients with malignant vasovagal syndrome. Metoprolol was an effective long term treatment for preventing syncope. High doses were more effective and a careful dose titration period helped to minimise withdrawal symptoms and side effects.