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Recurrent vasovagal syncope: comparison between clomipramine and nitroglycerin as drug challenges during head-up tilt testing.
Eur Heart J. 2009 Sep; 30(18):2249-53.EH

Abstract

AIMS

To compare the responses between clomipramine, a centrally acting substance, and nitroglycerin, with mainly peripheral action, when each drug is used during tilt test for the induction of vasovagal syncope (VVS).

METHODS AND RESULTS

Hundred patients with recurrent episodes of classical VVS underwent two tilt tests in a randomized sequence. One test included 20 min of tilt at 60 degrees with intravenous administration of 5 mg clomipramine (clomipramine tilt), whereas the other test included an initial 30 min period of passive 60 degrees tilt, followed by sublingual spray administration of 400 microg nitroglycerin (nitroglycerin tilt). Fifty asymptomatic subjects served as controls. Following clomipramine tilt, a positive response occurred in 73 patients (73%), a negative response in 23 (23%), and drug intolerance in 4 (4%). With nitroglycerin tilt, these percentages were 52, 48, and 0%, respectively. Significant differences were observed regarding positive responses (clomipramine vs. nitroglycerin: 73/100 vs. 52/100, P < 0.05), as well as negative responses (23/100 vs. 48/100, respectively, P < 0.05). A high concordance rate was observed in positive responses.

CONCLUSION

In the evaluation of patients with recurrent classical VVS, clomipramine tilt is associated with an increased positive yield relative to nitroglycerin tilt. This suggests that central mechanisms may be more important than peripheral ones in VVS pathogenesis.

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Authors+Show Affiliations

Flevari P
2nd Department of Cardiology, Attikon University Hospital, Athens, Greece. pflevari@yahoo.com
Leftheriotis D
No affiliation info available
Komborozos C
No affiliation info available
Fountoulaki K
No affiliation info available
Dagres N
No affiliation info available
Theodorakis G
No affiliation info available
Kremastinos D
No affiliation info available

MeSH

Administration, InhalationAdolescentAdultCentral Nervous System AgentsClomipramineFemaleHumansInjections, IntravenousMaleMiddle AgedNitroglycerinPeripheral Nervous System AgentsRandom AllocationRecurrenceSyncope, VasovagalTilt-Table TestYoung Adult

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19556259

Citation

Flevari, Panayota, et al. "Recurrent Vasovagal Syncope: Comparison Between Clomipramine and Nitroglycerin as Drug Challenges During Head-up Tilt Testing." European Heart Journal, vol. 30, no. 18, 2009, pp. 2249-53.
Flevari P, Leftheriotis D, Komborozos C, et al. Recurrent vasovagal syncope: comparison between clomipramine and nitroglycerin as drug challenges during head-up tilt testing. Eur Heart J. 2009;30(18):2249-53.
Flevari, P., Leftheriotis, D., Komborozos, C., Fountoulaki, K., Dagres, N., Theodorakis, G., & Kremastinos, D. (2009). Recurrent vasovagal syncope: comparison between clomipramine and nitroglycerin as drug challenges during head-up tilt testing. European Heart Journal, 30(18), 2249-53. https://doi.org/10.1093/eurheartj/ehp255
Flevari P, et al. Recurrent Vasovagal Syncope: Comparison Between Clomipramine and Nitroglycerin as Drug Challenges During Head-up Tilt Testing. Eur Heart J. 2009;30(18):2249-53. PubMed PMID: 19556259.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recurrent vasovagal syncope: comparison between clomipramine and nitroglycerin as drug challenges during head-up tilt testing. AU - Flevari,Panayota, AU - Leftheriotis,Dionyssios, AU - Komborozos,Christophoros, AU - Fountoulaki,Katerina, AU - Dagres,Nikolaos, AU - Theodorakis,George, AU - Kremastinos,Dimitrios, Y1 - 2009/06/25/ PY - 2009/6/27/entrez PY - 2009/6/27/pubmed PY - 2010/7/16/medline SP - 2249 EP - 53 JF - European heart journal JO - Eur Heart J VL - 30 IS - 18 N2 - AIMS: To compare the responses between clomipramine, a centrally acting substance, and nitroglycerin, with mainly peripheral action, when each drug is used during tilt test for the induction of vasovagal syncope (VVS). METHODS AND RESULTS: Hundred patients with recurrent episodes of classical VVS underwent two tilt tests in a randomized sequence. One test included 20 min of tilt at 60 degrees with intravenous administration of 5 mg clomipramine (clomipramine tilt), whereas the other test included an initial 30 min period of passive 60 degrees tilt, followed by sublingual spray administration of 400 microg nitroglycerin (nitroglycerin tilt). Fifty asymptomatic subjects served as controls. Following clomipramine tilt, a positive response occurred in 73 patients (73%), a negative response in 23 (23%), and drug intolerance in 4 (4%). With nitroglycerin tilt, these percentages were 52, 48, and 0%, respectively. Significant differences were observed regarding positive responses (clomipramine vs. nitroglycerin: 73/100 vs. 52/100, P < 0.05), as well as negative responses (23/100 vs. 48/100, respectively, P < 0.05). A high concordance rate was observed in positive responses. CONCLUSION: In the evaluation of patients with recurrent classical VVS, clomipramine tilt is associated with an increased positive yield relative to nitroglycerin tilt. This suggests that central mechanisms may be more important than peripheral ones in VVS pathogenesis. SN - 1522-9645 UR - https://www.unboundmedicine.com/medline/citation/19556259/Recurrent_vasovagal_syncope:_comparison_between_clomipramine_and_nitroglycerin_as_drug_challenges_during_head_up_tilt_testing_ L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehp255 DB - PRIME DP - Unbound Medicine ER -