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. 1997 Mar;77(3):268–272. doi: 10.1136/hrt.77.3.268

Malignant vasovagal syncope: a randomised trial of metoprolol and clonidine.

M Biffi 1, G Boriani 1, P Sabbatani 1, G Bronzetti 1, L Frabetti 1, R Zannoli 1, A Branzi 1, B Magnani 1
PMCID: PMC484696  PMID: 9093048

Abstract

OBJECTIVE: To evaluate the efficacy of head up tilt guided treatment with metoprolol and clonidine in preventing the recurrence of syncope in patients with malignant vasovagal syncope. PATIENTS: 20 patients (9 men and 11 women, mean age 33 (SD 17), range 14 to 62 years) with severe symptoms. DESIGN: Randomised double blind crossover trial; efficacy was assessed by head up tilt testing. RESULTS: Metoprolol was more effective than clonidine in abolishing syncope (19/20 v 1/20, P < 0.001) but clonidine showed some beneficial effects on time to syncope and severity of hypotension in 12 patients. During an average follow up of 15 (3) months there was a significant reduction in the recurrence of symptoms compared with the previous year in patients who had tilt up guided treatment (18 metoprolol, 1 clonidine). CONCLUSIONS: Treatment guided by head up tilting is a reliable method of treating patients with malignant vasovagal syndrome. Metoprolol was an effective long term treatment for preventing syncope. High doses were more effective and a careful dose titration period helped to minimise withdrawal symptoms and side effects.

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Selected References

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