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Syncope is a common problem in medical practice. Of the various types of syncope, the neurally mediated syncopal syndromes (of which vasovagal syncope is the most common) predominate. In most cases, neurally mediated syncope is a solitary event that can be managed with only reassurance, but certain patients (those with multiple recurrences or those who have been injured as a result of syncope) need further investigation and therapy. Dietary and lifestyle changes are crucial and often overlooked aspects of therapy that may be sufficient to control symptoms. Pharmacologic therapy, which usually starts with beta-blockers or fludrocortisone, can also be effective. Finally, certain patients may continue to have recurrences despite the use of both nonpharmacologic and pharmacologic therapy. It was recently demonstrated that permanent pacing may be effective in preventing recurrent syncopal episodes in some of these patients.

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References and Recommended Reading

  1. Benditt DG, Ferguson DW, Grubb BP, et al.: Tilt-table testing for assessing syncope. An American College of Cardiology expert consensus document. J Am Coll Cardiol 1996, 28:263–275. This consensus document evaluates the usefulness of tilt table testing in the evaluation of neurally mediated syncopal syndromes.

    Article  PubMed  CAS  Google Scholar 

  2. Benditt DG, Sakaguchi S, Schultz JJ, et al.: Syncope. Diagnostic considerations and the role of tilt table testing. Cardiol Rev 1993, 1:146–156.

    Article  Google Scholar 

  3. Kapoor W: Evaluation and outcome of patients with syncope. Medicine (Baltimore) 1990, 69:160–175.

    CAS  Google Scholar 

  4. Younoszai AK, Frankli WH, Chan DP, et al.: Oral fluid therapy. A promising treatment for vasodepressor syncope. Arch Pediatr Adolesc Med 1998, 152:165–168.

    PubMed  CAS  Google Scholar 

  5. Ector H, Reybrouck T, Heidbuchel H, et al.: Tilt training: a new treatment for recurrent neurocardiogenic syncope and severe orthostatic intolerance. Pacing Clin Electrophysiol 1998, 21:193–196.

    Article  PubMed  CAS  Google Scholar 

  6. Iskos D, Dutton J, Scheinman MM, Lurie KG: Usefulness of pindolol in neurocardiogenic syncope. Am J Cardiol 1998, 82:1121–1124.

    Article  PubMed  CAS  Google Scholar 

  7. Mahanonda N, Bhuripanyo K, Kangkagate C, et al.: Randomized double-blind placebo-controlled trial of oral atenolol in patients with unexplained syncope and positive upright tilt table results. Am Heart J 1995, 130:1250–1253.

    Article  PubMed  CAS  Google Scholar 

  8. Sra JS, Murthy VS, Jazayeri MR, et al.: Use of intravenous esmolol to predict efficacy of oral adrenergic blocker therapy in patients with neurocardiogenic syncope. J Am Coll Cardiol 1993, 19:402–408.

    Article  Google Scholar 

  9. Milstein S, Buetikofer J, Dunnigan A, et al.: Usefulness of disopyramide for prevention of upright tiltinduced hypotension-bradycardia. Am J Cardiol 1990, 65:1339–1344.

    Article  PubMed  CAS  Google Scholar 

  10. Morillo C, Leitch JW, Yee R, Klein GJ: A placebo-controlled trial of intravenous and oral disopyramide for prevention of neurally mediated syncope induced by head-up tilt. J Am Coll Cardiol 1993 22:1843–1848.

    Article  PubMed  CAS  Google Scholar 

  11. Kosinski DJ, Grubb BP, Temesy-Armos PN: The use of serotonin re-uptake inhibitors in the treatment of neurally mediated cardiovascular disorders. J Serotonin Res 1994, 1:85–90.

    Google Scholar 

  12. Grubb BP, Wolfe D, Samoil D, et al.: Usefulness of fluoxetine hydrochloride for prevention of resistant upright tilt induced syncope. Pacing Clin Electrophysiol 1993, 16:458–464.

    Article  PubMed  CAS  Google Scholar 

  13. Grubb BP, Samoil D, Kosinski D, et al.: The use of serotonin reuptake inhibitors for the treatment of caroti sinus hypersensitivity syndrome unresponsive to dual chamber pacing. Pacing Clin Electrophysiol 1994, 17:1434–1436.

    Article  PubMed  CAS  Google Scholar 

  14. Low PA, Gilden JL, Freeman R, et al.: Efficacy of midodrine vs placebo in neurogenic orthostatic hypotension. JAMA 1997, 13:1046–1051. This published report of a trial of midodrine details the efficacy of this agent in the treatment of orthostatic hypotension.

    Article  Google Scholar 

  15. Sra J, Maglio C, Biehl M, et al.: Efficacy of midodrine hydrochloride in neurocardiogenic syncope refractory to standard therapy. J Cardiovasc Electrophysiol 1997, 8:42–46.

    Article  PubMed  CAS  Google Scholar 

  16. Scott WA, Pongiglione G, Bromberg BI, et al.: Randomized comparison of atenolol and fludrocortisone acetate in the treatment of pediatric neurally mediated syncope. Am J Cardiol 1995, 76:400–402.

    Article  PubMed  CAS  Google Scholar 

  17. Benditt DG, Petersen M, Lurie KG, et al.: Cardiac pacing for the prevention of recurrent vasovagal syncope. Ann Intern Med 1995, 122:204–209.

    PubMed  CAS  Google Scholar 

  18. Fitzpatrick A, Theodorakis G, Ahmed R, et al.: Dual chamber pacing aborts vasovagal syncope induced by head-up 60 degree tilt. Pacing Clin Electrophysiol 1991, 14:13–19.

    Article  PubMed  CAS  Google Scholar 

  19. Samoil D, Grubb BP, Brewster P, et al.: Comparison of single and dual chamber pacing techniques in prevention of upright tilt induced vasovagal syncope. Eur J Cardiac Pacing Electrophysiol 1993, 1:36–41.

    Google Scholar 

  20. Sheldon R, Koshman ML, Wilso W, et al.: Effect of dual-chamber pacing with automatic rate-drop sensing on recurrent neurally mediated syncope. Am J Cardiol 1998, 81:158–162.

    Article  PubMed  CAS  Google Scholar 

  21. Connolly SJ, Sheldon R, Roberts RS, et al.: The North American Vasovagal Pacemaker Study (VPS). A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. J Am Coll Cardiol 1999, 33:16–20. This recent publication from a multicenter trial examines the usefulness of permanent pacing therapy in patients with neurally mediated syncope.

    Article  PubMed  CAS  Google Scholar 

  22. Benditt DG: Cardiac pacing for prevention of vasovagal syncope. J Am Coll Cardiol 1999, 33:21–23.

    Article  PubMed  CAS  Google Scholar 

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Fabian, W.H., Benditt, D.G. & Lurie, K.G. Neurally mediated syncope. Curr Treat Options Cardio Med 1, 137–144 (1999). https://doi.org/10.1007/s11936-999-0017-5

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  • DOI: https://doi.org/10.1007/s11936-999-0017-5

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