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Usefulness of intravenous metoprolol during positive isoproterenol tilt-table test in the choice of treatment for neurocardiogenic syncope.
Indian Heart J. 2003 Jan-Feb; 55(1):40-3.IH

Abstract

BACKGROUND

Isoproterenol tilt-table testing provides a diagnosis of neurocardiogenic syncope in patients with syncope or near-syncope. Although acute beta-blockade may prevent the development of syncope during isoproterenol tilt-table testing, the use of beta-blockers for chronic prophylaxis may not be effective for some patients who show a positive response to isoproterenol tilt-table testing. We evaluated whether the efficacy of intravenous metoprolol in preventing symptoms during repeated tests would be helpful in selecting patients suitable for long-term therapy.

METHODS AND RESULTS

We studied 55 patients (35 females, 20 males; mean age 36+/-11 years) who had been chosen from a group referred to our institute with a history of unexplained syncope (> or = 2 syncopal episodes) and a positive response to isoproterenol tilt-table testing. After a positive response to isoproterenol tilt-table testing, 5 mg metoprolol was infused intravenously as a bolus and the test repeated. Thirty-five patients (group 1) showed a positive response again and 20 (group 2) showed a negative response. We started 50 mg metoprolol once a day for patients in group 1 while group 2 was divided into 2 subgroups: the first subgroup (group 2a, 12 patients) was started on 50 mg sertraline or 20 mg paroxetine once a day and the second subgroup (group 2b, 8 patients) was started on 5 mg midodrine orally once a day. Two months later, isoproterenol tilt-table testing was repeated. In group 1, 13 of 35 patients (37%) were positive on isoproterenol tilt-table testing while in group 2, 8 of 20 patients (40%) were positive on isoproterenol tilt-table testing (p not statistically significant). The therapies of the two groups were then interchanged. Two months later (4 months from the beginning of the study), the isoproterenol tilt-table test was repeated. Eleven patients in group 1 (31%) and 6 in group 2 (30%, p not statistically significant) showed a positive response again.

CONCLUSIONS

We conclude that acute beta-blockade response to positive isoproterenol tilt-table testing is not a useful predictor for the assessment of chronic prophylaxis for neurocardiogenic syncope.

Authors+Show Affiliations

Baran I
Department of Cardiology, Uludag University, School of Medicine, Bursa, Turkey.
Gemici K
No affiliation info available
Ozdemir B
No affiliation info available
Saraç M
No affiliation info available
Güllülü S
No affiliation info available
Aydinlar A
No affiliation info available
Cordan J
No affiliation info available

MeSH

Adrenergic beta-AgonistsAdrenergic beta-AntagonistsAdultFemaleHumansIsoproterenolMaleMetoprololMiddle AgedSyncope, VasovagalTilt-Table Test

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12760586

Citation

Baran, Ibrahim, et al. "Usefulness of Intravenous Metoprolol During Positive Isoproterenol Tilt-table Test in the Choice of Treatment for Neurocardiogenic Syncope." Indian Heart Journal, vol. 55, no. 1, 2003, pp. 40-3.
Baran I, Gemici K, Ozdemir B, et al. Usefulness of intravenous metoprolol during positive isoproterenol tilt-table test in the choice of treatment for neurocardiogenic syncope. Indian Heart J. 2003;55(1):40-3.
Baran, I., Gemici, K., Ozdemir, B., Saraç, M., Güllülü, S., Aydinlar, A., & Cordan, J. (2003). Usefulness of intravenous metoprolol during positive isoproterenol tilt-table test in the choice of treatment for neurocardiogenic syncope. Indian Heart Journal, 55(1), 40-3.
Baran I, et al. Usefulness of Intravenous Metoprolol During Positive Isoproterenol Tilt-table Test in the Choice of Treatment for Neurocardiogenic Syncope. Indian Heart J. 2003 Jan-Feb;55(1):40-3. PubMed PMID: 12760586.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Usefulness of intravenous metoprolol during positive isoproterenol tilt-table test in the choice of treatment for neurocardiogenic syncope. AU - Baran,Ibrahim, AU - Gemici,Kani, AU - Ozdemir,Bülent, AU - Saraç,Murat, AU - Güllülü,Sümeyye, AU - Aydinlar,Ali, AU - Cordan,Jale, PY - 2003/5/23/pubmed PY - 2003/9/4/medline PY - 2003/5/23/entrez SP - 40 EP - 3 JF - Indian heart journal JO - Indian Heart J VL - 55 IS - 1 N2 - BACKGROUND: Isoproterenol tilt-table testing provides a diagnosis of neurocardiogenic syncope in patients with syncope or near-syncope. Although acute beta-blockade may prevent the development of syncope during isoproterenol tilt-table testing, the use of beta-blockers for chronic prophylaxis may not be effective for some patients who show a positive response to isoproterenol tilt-table testing. We evaluated whether the efficacy of intravenous metoprolol in preventing symptoms during repeated tests would be helpful in selecting patients suitable for long-term therapy. METHODS AND RESULTS: We studied 55 patients (35 females, 20 males; mean age 36+/-11 years) who had been chosen from a group referred to our institute with a history of unexplained syncope (> or = 2 syncopal episodes) and a positive response to isoproterenol tilt-table testing. After a positive response to isoproterenol tilt-table testing, 5 mg metoprolol was infused intravenously as a bolus and the test repeated. Thirty-five patients (group 1) showed a positive response again and 20 (group 2) showed a negative response. We started 50 mg metoprolol once a day for patients in group 1 while group 2 was divided into 2 subgroups: the first subgroup (group 2a, 12 patients) was started on 50 mg sertraline or 20 mg paroxetine once a day and the second subgroup (group 2b, 8 patients) was started on 5 mg midodrine orally once a day. Two months later, isoproterenol tilt-table testing was repeated. In group 1, 13 of 35 patients (37%) were positive on isoproterenol tilt-table testing while in group 2, 8 of 20 patients (40%) were positive on isoproterenol tilt-table testing (p not statistically significant). The therapies of the two groups were then interchanged. Two months later (4 months from the beginning of the study), the isoproterenol tilt-table test was repeated. Eleven patients in group 1 (31%) and 6 in group 2 (30%, p not statistically significant) showed a positive response again. CONCLUSIONS: We conclude that acute beta-blockade response to positive isoproterenol tilt-table testing is not a useful predictor for the assessment of chronic prophylaxis for neurocardiogenic syncope. SN - 0019-4832 UR - https://www.unboundmedicine.com/medline/citation/12760586/Usefulness_of_intravenous_metoprolol_during_positive_isoproterenol_tilt_table_test_in_the_choice_of_treatment_for_neurocardiogenic_syncope_ DB - PRIME DP - Unbound Medicine ER -