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The effect of atropine in vasovagal syncope induced by head-up tilt testing.
Eur Heart J. 1999 Dec; 20(23):1745-51.EH

Abstract

AIMS

This single-blinded, randomized, placebo-controlled study was designed and undertaken to assess the efficacy of intravenous atropine administration on haemodynamic impairment induced by head-up tilt testing in patients with vasovagal syncope.

METHODS AND RESULTS

One hundred and thirteen consecutive patients (62 male and 51 female, mean age 46.3 years) with recurrent syncope, no evidence of cardiac, neurological or metabolic disease and a positive head-up tilt test were included in the study. Within 2 weeks of the first head-up tilt test all patients underwent a second tilt test. During this second test, all patients were randomized to receive a bolus of either atropine (0.02 mg. kg(-1)) or placebo (isotonic saline solution). The administration of atropine or placebo was performed at the onset of the haemodynamic modifications (heart rate and/or blood pressure fall) in conjunction with typical vasovagal prodromal symptoms. Treatment was taken as effective when symptoms aborted and the test was completed. In 29 of 113 patients the second tilt test was negative and these patients were excluded from final data analysis. Forty-one patients received placebo, which was effective in nine cases (21.9%). Atropine was administered to 43 patients and was effective in 30 cases (69.7%, P<0.01 vs placebo). The effects of treatment were analysed further to consider the haemodynamic patterns of tilt-induced vasovagal reflex. In the cardio-inhibitory form, placebo was never effective (15 cases), while atropine was effective in 15 of 18 cases (83.3%, P<0.001 vs placebo). In the vasodepressor form, placebo was effective in nine of 26 patients (34.6%), while atropine was effective in 15 of 25 cases (60.0%, no significant difference vs placebo).

CONCLUSIONS

Atropine is fully effective in the cardio-inhibitory form of tilt-induced vasovagal reflex, but is limited in the vasodepressor form.

Links

Publisher Full Text

Authors+Show Affiliations

Santini M
Heart Disease Department, S. Filippo Neri Hospital, Rome, Italy.
Ammirati F
No affiliation info available
Colivicchi F
No affiliation info available
Gentilucci G
No affiliation info available
Guido V
No affiliation info available

MeSH

AtropineElectrocardiography, AmbulatoryFemaleHemodynamicsHumansInjections, IntravenousMaleMiddle AgedParasympatholyticsPostureReflexSingle-Blind MethodSyncope, VasovagalTilt-Table TestVagus Nerve

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

10562483

Citation

Santini, M, et al. "The Effect of Atropine in Vasovagal Syncope Induced By Head-up Tilt Testing." European Heart Journal, vol. 20, no. 23, 1999, pp. 1745-51.
Santini M, Ammirati F, Colivicchi F, et al. The effect of atropine in vasovagal syncope induced by head-up tilt testing. Eur Heart J. 1999;20(23):1745-51.
Santini, M., Ammirati, F., Colivicchi, F., Gentilucci, G., & Guido, V. (1999). The effect of atropine in vasovagal syncope induced by head-up tilt testing. European Heart Journal, 20(23), 1745-51.
Santini M, et al. The Effect of Atropine in Vasovagal Syncope Induced By Head-up Tilt Testing. Eur Heart J. 1999;20(23):1745-51. PubMed PMID: 10562483.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of atropine in vasovagal syncope induced by head-up tilt testing. AU - Santini,M, AU - Ammirati,F, AU - Colivicchi,F, AU - Gentilucci,G, AU - Guido,V, PY - 1999/11/24/pubmed PY - 2000/10/7/medline PY - 1999/11/24/entrez SP - 1745 EP - 51 JF - European heart journal JO - Eur Heart J VL - 20 IS - 23 N2 - AIMS: This single-blinded, randomized, placebo-controlled study was designed and undertaken to assess the efficacy of intravenous atropine administration on haemodynamic impairment induced by head-up tilt testing in patients with vasovagal syncope. METHODS AND RESULTS: One hundred and thirteen consecutive patients (62 male and 51 female, mean age 46.3 years) with recurrent syncope, no evidence of cardiac, neurological or metabolic disease and a positive head-up tilt test were included in the study. Within 2 weeks of the first head-up tilt test all patients underwent a second tilt test. During this second test, all patients were randomized to receive a bolus of either atropine (0.02 mg. kg(-1)) or placebo (isotonic saline solution). The administration of atropine or placebo was performed at the onset of the haemodynamic modifications (heart rate and/or blood pressure fall) in conjunction with typical vasovagal prodromal symptoms. Treatment was taken as effective when symptoms aborted and the test was completed. In 29 of 113 patients the second tilt test was negative and these patients were excluded from final data analysis. Forty-one patients received placebo, which was effective in nine cases (21.9%). Atropine was administered to 43 patients and was effective in 30 cases (69.7%, P<0.01 vs placebo). The effects of treatment were analysed further to consider the haemodynamic patterns of tilt-induced vasovagal reflex. In the cardio-inhibitory form, placebo was never effective (15 cases), while atropine was effective in 15 of 18 cases (83.3%, P<0.001 vs placebo). In the vasodepressor form, placebo was effective in nine of 26 patients (34.6%), while atropine was effective in 15 of 25 cases (60.0%, no significant difference vs placebo). CONCLUSIONS: Atropine is fully effective in the cardio-inhibitory form of tilt-induced vasovagal reflex, but is limited in the vasodepressor form. SN - 0195-668X UR - https://www.unboundmedicine.com/medline/citation/10562483/The_effect_of_atropine_in_vasovagal_syncope_induced_by_head_up_tilt_testing_ L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1053/euhj.1999.1697 DB - PRIME DP - Unbound Medicine ER -