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Acute and long-term beta-adrenergic blockade for patients with neurocardiogenic syncope.
J Am Coll Cardiol. 1995 Nov 01; 26(5):1293-8.JACC

Abstract

OBJECTIVES

This study was designed to prospectively evaluate the long-term outcome of drug therapy guided by head-up tilt testing for the management of unexplained syncope and near syncope.

BACKGROUND

Head-up tilt testing is used to evaluate patients with unexplained syncope. The validity of acute drug testing and the efficacy of long-term oral therapy for prevention of recurrent syncope have not been investigated in large patient groups.

METHODS

We studied 296 consecutive patients with unexplained syncope or near syncope who underwent 80 degrees head-up tilt testing with and without isoproterenol challenge. The efficacy of intravenous and oral beta-blocker therapy was evaluated by repeat testing. Patients with both positive and negative responses to therapy were followed up for rates of recurrence of syncope.

RESULTS

A total of 193 patients (65%) had a positive tilt test response; 89% of these 193 required isoproterenol challenge to elicit this response. Patients with a positive tilt test result had lower values for heart rate at rest (mean +/- SD 69 +/- 13 vs. 74 +/- 14 beats/min, p = 0.046) and systolic blood pressure (137 +/- 28 vs. 145 +/- 30 mm Hg, p = 0.0018) at baseline than did the patients with a negative tilt test result. Intravenous propranolol blocked the positive response in 163 (90%) of 181 patients retested. Oral beta-blockers were effective by tilt test criteria in 118 (94%) of 125 patients; 12 (10%) had recurrent clinical symptoms while taking beta-blockers. Eight (42%) of 19 patients who had a negative tilt test response during beta-blocker therapy had recurrent symptoms when they stopped therapy. Three (23%) of 13 patients receiving empiric beta-blocker therapy had recurrent symptoms. The follow-up period for the patients with a positive tilt test result was 28 +/- 11 months (range 5 to 48).

CONCLUSIONS

Intravenous propranolol is effective in preventing neurocardiogenic syncope diagnosed during head-up tilt testing and predicts the response to oral beta-blocker therapy. Oral beta-blocker therapy prevents recurrent syncope in the majority of patients. Recurrence of syncope is lowest when efficacy of oral beta-blocker therapy is confirmed by repeat head-up tilt testing.

Authors+Show Affiliations

Cox MM
Division of Cardiology, University of Miami, School of Medicine, Florida 33101, USA.
Perlman BA
No affiliation info available
Mayor MR
No affiliation info available
Silberstein TA
No affiliation info available
Levin E
No affiliation info available
Pringle L
No affiliation info available
Castellanos A
No affiliation info available
Myerburg RJ
No affiliation info available

MeSH

Administration, OralAdrenergic beta-AntagonistsAdultAgedFemaleFollow-Up StudiesHumansInjections, IntravenousIsoproterenolMaleMiddle AgedPropranololProspective StudiesSyncopeTilt-Table Test

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

7594046

Citation

Cox, M M., et al. "Acute and Long-term Beta-adrenergic Blockade for Patients With Neurocardiogenic Syncope." Journal of the American College of Cardiology, vol. 26, no. 5, 1995, pp. 1293-8.
Cox MM, Perlman BA, Mayor MR, et al. Acute and long-term beta-adrenergic blockade for patients with neurocardiogenic syncope. J Am Coll Cardiol. 1995;26(5):1293-8.
Cox, M. M., Perlman, B. A., Mayor, M. R., Silberstein, T. A., Levin, E., Pringle, L., Castellanos, A., & Myerburg, R. J. (1995). Acute and long-term beta-adrenergic blockade for patients with neurocardiogenic syncope. Journal of the American College of Cardiology, 26(5), 1293-8.
Cox MM, et al. Acute and Long-term Beta-adrenergic Blockade for Patients With Neurocardiogenic Syncope. J Am Coll Cardiol. 1995 Nov 1;26(5):1293-8. PubMed PMID: 7594046.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute and long-term beta-adrenergic blockade for patients with neurocardiogenic syncope. AU - Cox,M M, AU - Perlman,B A, AU - Mayor,M R, AU - Silberstein,T A, AU - Levin,E, AU - Pringle,L, AU - Castellanos,A, AU - Myerburg,R J, PY - 1995/11/1/pubmed PY - 1995/11/1/medline PY - 1995/11/1/entrez SP - 1293 EP - 8 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 26 IS - 5 N2 - OBJECTIVES: This study was designed to prospectively evaluate the long-term outcome of drug therapy guided by head-up tilt testing for the management of unexplained syncope and near syncope. BACKGROUND: Head-up tilt testing is used to evaluate patients with unexplained syncope. The validity of acute drug testing and the efficacy of long-term oral therapy for prevention of recurrent syncope have not been investigated in large patient groups. METHODS: We studied 296 consecutive patients with unexplained syncope or near syncope who underwent 80 degrees head-up tilt testing with and without isoproterenol challenge. The efficacy of intravenous and oral beta-blocker therapy was evaluated by repeat testing. Patients with both positive and negative responses to therapy were followed up for rates of recurrence of syncope. RESULTS: A total of 193 patients (65%) had a positive tilt test response; 89% of these 193 required isoproterenol challenge to elicit this response. Patients with a positive tilt test result had lower values for heart rate at rest (mean +/- SD 69 +/- 13 vs. 74 +/- 14 beats/min, p = 0.046) and systolic blood pressure (137 +/- 28 vs. 145 +/- 30 mm Hg, p = 0.0018) at baseline than did the patients with a negative tilt test result. Intravenous propranolol blocked the positive response in 163 (90%) of 181 patients retested. Oral beta-blockers were effective by tilt test criteria in 118 (94%) of 125 patients; 12 (10%) had recurrent clinical symptoms while taking beta-blockers. Eight (42%) of 19 patients who had a negative tilt test response during beta-blocker therapy had recurrent symptoms when they stopped therapy. Three (23%) of 13 patients receiving empiric beta-blocker therapy had recurrent symptoms. The follow-up period for the patients with a positive tilt test result was 28 +/- 11 months (range 5 to 48). CONCLUSIONS: Intravenous propranolol is effective in preventing neurocardiogenic syncope diagnosed during head-up tilt testing and predicts the response to oral beta-blocker therapy. Oral beta-blocker therapy prevents recurrent syncope in the majority of patients. Recurrence of syncope is lowest when efficacy of oral beta-blocker therapy is confirmed by repeat head-up tilt testing. SN - 0735-1097 UR - https://www.unboundmedicine.com/medline/citation/7594046/Acute_and_long_term_beta_adrenergic_blockade_for_patients_with_neurocardiogenic_syncope_ DB - PRIME DP - Unbound Medicine ER -