Are treatments for vasovagal syncope effective? A meta-analysis

作者：Vyas Ankur^*; Swaminathan Paari Dominic; Zimmerman Miriam B; Olshansky Brian

来源：International Journal of Cardiology, 2013, 167(5): 1906-1911.

DOI：10.1016/j.ijcard.2012.04.144

• Syncope
• Tilt training
• Vaso-vagal syncope
• Neurocardiogenic syncope
• Alpha-adrenergic agonists
• Beta-adrenergic blockers

Background: Therapies used to treat vaso-vagal syncope (VVS) recurrence have not been proven effective in single studies. %26lt;br%26gt;Methods: Comprehensive search of PubMed, EMBASE and Cochrane Central databases of published trials was done. Randomized or non-randomized studies, comparing the intervention of interest to control group(s), with the endpoint of spontaneous recurrence or syncope on head-up tilt test, were included. Data were extracted on an intention-to-treat basis. Study heterogeneity was analyzed by Cochran%26apos;s Q statistics. A random-effect analysis was used. %26lt;br%26gt;Results: alpha-adrenergic agonists were found effective (n=400, OR 0.19, CI 0.06-0.62, p%26lt;0.05) in preventing VVS recurrence. beta-blockers were not found to be effective when only randomized studies comparing beta-blockers to non-pharmacologic agents were assessed (9 studies, n=583, OR 0.48, CI 0.22-1.04, p=0.06). Tilt-training had no effect when only randomized studies were considered (4 studies, n=298, OR 0.47, CI 0.21-1.05, p=0.07). Selective serotonin reuptake inhibitors were found effective (n=131, OR 0.28, CI 0.10-0.74, p%26lt;0.05), though the analysis contained only 2 studies. Pacemakers were found effective in preventing syncope recurrence when all studies were analyzed (n=463, OR 0.13, CI 0.05-0.36, p%26lt;0.05). However, studies comparing active pacemaker to sensing mode only did not show benefit (3 studies, n=162, OR 0.45, CI 0.09-2.14, p=0.32). %26lt;br%26gt;Conclusions: This meta-analysis highlights the totality of evidence for commonly used medications used to treat VVS, and the requirement for larger, double-blind, placebo controlled trials with longer follow-up.

• 出版日期2013-9-1