Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2011 Oct 5;2011(10):CD004194.
doi: 10.1002/14651858.CD004194.pub3.

Drugs and pacemakers for vasovagal, carotid sinus and situational syncope

Jacobus Jcm Romme  1 , Johannes B Reitsma, Catherine N Black, Nancy Colman, Rob Jpm Scholten, Wouter Wieling, Nynke Van Dijk
Affiliations
Meta-Analysis

Drugs and pacemakers for vasovagal, carotid sinus and situational syncope

Jacobus Jcm Romme et al. Cochrane Database Syst Rev. .

Abstract

Background: Neurally mediated reflex syncope is the most common cause of transient loss of consciousness. In patients not responding to non-pharmacological treatment, pharmacological or pacemaker treatment might be considered.

Objectives: To examine the effects of pharmacological therapy and pacemaker implantation in patients with vasovagal syncope, carotid sinus syncope and situational syncope.

Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 1, 2008), PubMed (1950 until February 2008), EMBASE on OVID (1980 until February 2008) and CINAHL on EBSCOhost (1937 until February 2008). No language restrictions were applied.

Selection criteria: We included parallel randomized controlled trials and randomized cross-over trials of pharmacological treatment (beta-blockers, fludrocortisone, alpha-adrenergic agonists, selective serotonine reuptake inhibitors, ACE inhibitors, disopyramide, anticholinergic agents or salt tablets) or dual chamber pacemaker treatment. Studies were included if pharmacological or pacemaker treatment was compared with any form of standardised control treatment (standard treatment), placebo treatment, or (other) pharmacological or pacemaker treatment. We did not include non-randomized studies.

Data collection and analysis: Two reviewers independently assessed the risk of bias. Using a standardised data extraction form, they extracted characteristics and results of the various studies. In a consensus meeting they discussed any disagreements that had occurred during data extraction. If no agreement could be reached, a third reviewer was asked to make a decision. Summary estimates with 95% confidence intervals of treatment effect were calculated using relative risks, rate ratios or weighted means differences depending on the type of outcome reported.

Main results: We included 46 randomized studies, 40 on vasovagal syncope and six on carotid sinus syncope. No studies on situational syncope matched the criteria for inclusion in our review. Studies in general were small with a median sample size of 42. A wide range of control treatments were used with 22 studies using a placebo arm. Blinding of patients and treating physicians was applied in eight studies. Results varied considerably between studies and between types of outcomes.For vasovagal syncope, the occurrence of syncope upon provocational head-up tilt testing was lower upon treatment with beta-blockers, ACE-inhibitors and anticholinergic agents compared to standard treatment. For carotid sinus syncope, the occurrence of syncope upon carotid sinus massage was lower on midodrine treatment compared to placebo treatment in one study.

Authors' conclusions: There is insufficient evidence to support the use of any of the pharmacological or pacemaker treatments for vasovagal syncope and carotid sinus syncope. Larger studies using patient relevant outcomes are needed.

PubMed Disclaimer

Conflict of interest statement

Wouter Wieling is a member of the steering committee of the ISSUE‐3‐study and is recipient of two study grants provided by the Dutch Heart Foundation.

Wouter Wieling, Jacobus JCM Romme, Nynke van Dijk and Johannes B Reitsma are investigators of the STAND. Nycomed was an unrestricted provider of medication for the STAND.

Figures

1
1
QUORUM statement flow diagram
2
2
Methodological quality graph: review authors' judgments about each methodological quality item presented as percentages across all included studies.
3
3
Methodological quality summary: review authors' judgments about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Vasovagal syncope. Beta‐blockers vs. standard treatment., Outcome 1 Proportion of patients with one or more syncopal episode(s) during follow‐up..
1.2
1.2. Analysis
Comparison 1 Vasovagal syncope. Beta‐blockers vs. standard treatment., Outcome 2 Proportion of patients with syncopal episodes induced by provocation testing..
2.1
2.1. Analysis
Comparison 2 Vasovagal syncope. Beta‐blockers vs. placebo., Outcome 1 Proportion of patients with one or more syncopal episode(s) during follow‐up..
2.2
2.2. Analysis
Comparison 2 Vasovagal syncope. Beta‐blockers vs. placebo., Outcome 2 Proportion of patients with syncopal episodes induced by provocation testing..
2.3
2.3. Analysis
Comparison 2 Vasovagal syncope. Beta‐blockers vs. placebo., Outcome 3 Proportion of patients with side effects..
3.1
3.1. Analysis
Comparison 3 Vasovagal syncope. Alpha‐adrenergic agents vs. placebo., Outcome 1 Proportion of patients with syncopal episodes induced by provocation testing. Treatment initiation before provocation testing..
3.2
3.2. Analysis
Comparison 3 Vasovagal syncope. Alpha‐adrenergic agents vs. placebo., Outcome 2 Proportion of patients with syncopal episodes induced by provocation testing. Treatment initiation before provocation testing..
3.3
3.3. Analysis
Comparison 3 Vasovagal syncope. Alpha‐adrenergic agents vs. placebo., Outcome 3 Proportion of patients with syncopal episodes induced by provocation testing. Treatment initiation after the occurrence of symptoms..
3.4
3.4. Analysis
Comparison 3 Vasovagal syncope. Alpha‐adrenergic agents vs. placebo., Outcome 4 Proportion of patients with side effects..
4.1
4.1. Analysis
Comparison 4 Vasovagal syncope. Selective serotonin reuptake inhibitors vs. placebo., Outcome 1 Proportion of patients with syncopal episodes induced by provocation testing..
4.2
4.2. Analysis
Comparison 4 Vasovagal syncope. Selective serotonin reuptake inhibitors vs. placebo., Outcome 2 Proportion of patients with one or more syncopal episode(s) during follow‐up..
5.1
5.1. Analysis
Comparison 5 Vasovagal syncope. ACE‐inhibitors vs. placebo., Outcome 1 Proportion of patients with syncopal episodes induced by provocation testing..
6.1
6.1. Analysis
Comparison 6 Vasovagal syncope. Anticholinergic agents vs. placebo., Outcome 1 Proportion of patients with syncopal episodes induced by provocation testing. Treatment initiation after the occurrence of symptoms..
7.1
7.1. Analysis
Comparison 7 Vasovagal syncope. DDD‐pacemaker vs. conventional standard therapy., Outcome 1 Proportion of patients with one or more syncopal episode(s) during follow‐up..
7.2
7.2. Analysis
Comparison 7 Vasovagal syncope. DDD‐pacemaker vs. conventional standard therapy., Outcome 2 Average time elapsed from start of an intervention until the first episode of syncope..
8.1
8.1. Analysis
Comparison 8 Vasovagal syncope. Active DDD‐pacemaker vs. non‐active pacemaker.., Outcome 1 Proportion of patients with one or more syncopal episode(s) during follow‐up..
8.2
8.2. Analysis
Comparison 8 Vasovagal syncope. Active DDD‐pacemaker vs. non‐active pacemaker.., Outcome 2 Proportion of patients with minor physical trauma due to syncope..
8.3
8.3. Analysis
Comparison 8 Vasovagal syncope. Active DDD‐pacemaker vs. non‐active pacemaker.., Outcome 3 Proportion of patients with side effects..
9.1
9.1. Analysis
Comparison 9 Vasovagal syncope. DDD‐pacemaker vs. DDI‐pacemaker., Outcome 1 Proportion of patients with one or more syncopal episode(s) during follow‐up..
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Ammirati 1998 {published data only}
    1. Ammirati F, Colivicchi F, Toscano S, Pandozi C, Laudadio MT, Seta F, et al. DDD pacing with rate drop response function versus DDI with rate hysteresis pacing for cardioinhibitory vasovagal syncope. Pacing and Clinical Electrophysiology 1998;21(11 Pt 2):2178‐81. - PubMed
    1. Ammirati, Colivicchi F. Electrostimulation in the cardioinibitory vasovagal syncope: pacing DDD with "rate‐drop response" versus pacing DDI with hysteresis. Giornale Italiano.di Cardiologia 1997;27:80.
Ammirati 2000 {published data only}
    1. Ammirati F, Colivicchi F, Santini M. Effects of intravenous etilefrine in neurocardiogenic syncope induced by head‐up tilt testing. American Journal of Cardiology 2000;86(4):472‐4. - PubMed
Ammirati 2001 {published data only}
    1. Ammirati F, Colivicchi F, Santini M. Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope: a multicenter, randomized, controlled trial. Circulation 2001;104(1):52‐7. - PubMed
Biffi 1997 {published data only}
    1. Biffi M, Boriani G, Sabbatani P, Bronzetti G, Frabetti L, Zannoli R, et al. Malignant vasovagal syncope: a randomised trial of metoprolol and clonidine. Heart 1997;77(3):268‐72. - PMC - PubMed
    1. Biffi, Boriani M. Treatment with the maligna vasovagal syncope: effect of metoprolol and clonidine. Giornale Italiano.di Cardiologia 1996;26:210.
Brignole 1988 {published data only}
    1. Brignole M, Menozzi C, Lolli G, Sartore B, Barra M. Natural and unnatural history of patients with severe carotid sinus hypersensitivity: a preliminary study. Pacing and Clinical Electrophysiology 1988;11:1628‐35. - PubMed
    1. Brignole M, Sartore B, Barra M, Menozzi C, Lolli G. Is DDD superior to VVI pacing in mixed carotid sinus syndrome? An acute and medium‐term study. Pacing and Clinical Electrophysiology 1988;11:1902‐10. - PubMed
Brignole 1992a {published data only}
    1. Brignole M, Menozzi C, Gianfranchi L, Lolli G, Bottoni N, Oddone D. A controlled trial of acute and long‐term medical therapy in tilt‐induced neurally mediated syncope. American Journal of Cardiology 1992;70(3):339‐42. - PubMed
Brignole 1992b {published data only}
    1. Brignole M, Barra M, Sartore B, Menozzi C, Lolli G. Comparison of permanent cardiac pacing and cardiac pacing on demand in mixed carotid sinus syndrome. Acute‐ and medium‐term follow‐up study. Giornale Italiano di Cardiologia 1988;18(1):32‐8. - PubMed
    1. Brignole M, Menozzi C, Lolli G, Bottoni N, Gaggioli G. Long‐term outcome of paced and nonpaced patients with severe carotid sinus syndrome. American Journal of Cardiology 1992;69(12):1039‐43. - PubMed
Claesson 2007 {published data only}
    1. Claesson JE, Kristensson BE, Edvardsson N, Wahrborg P. Less syncope and milder symptoms in patients treated with pacing for induced cardioinhibitory carotid sinus syndrome: a randomized study. Europace. 2007;9(10):932‐6. - PubMed
Connolly 1999 {published data only}
    1. Connolly SJ, Sheldon R, Roberts RS, Gent M. The North American Vasovagal Pacemaker Study (VPS). A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. Journal of the American College of Cardiology 1999;33(1):16‐20. - PubMed
Connolly 2003 {published data only}
    1. Connolly SJ, Sheldon R, Thorpe KE, Roberts RS, Ellenbogen KA, Wilkoff BL, et al. Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope: second Vasovagal Pacemaker Study (VPS II): a randomized trial. JAMA 2003;289(17):2224‐9. - PubMed
    1. Connolly SJ, Sheldon R, Thorpe KE, Roberts RS, Ellenbogen KA, Wilkoff BL, et al. The second vasovagal pacemaker study (VPSii). Pacing & Clinical Electrophysiology 2003;26(7 Part 1):1565.
Deharo 2003 {published data only}
    1. Deharo JC, Brunetto AB, Bellocci F, Barbonaglia L, Occhetta E, Fasciolo L, et al. DDDR pacing driven by contractility versus DDI pacing in vasovagal syncope: a multicenter, randomized study. Pacing and Clinical Electrophysiology 2003;26(1 Pt 2):447‐50. - PubMed
Di Girolamo 1998 {published data only}
    1. Girolamo E, Iorio C, Sabatini P, Leonzio L, Barsotti A. Evaluation of the effects of diverse therapeutic treatments versus no treatment of patients with neurocardiogenic syncope. Cardiologia 1998;43(8):833‐7. - PubMed
Di Girolamo 1999 {published data only}
    1. Girolamo E, Iorio C, Leonzio L, Sabatini P, Ranalli G, Barsotti A. Effectiveness of paroxetine in the treatment of refractory vasovagal syncope in young patients. Giornale Italiano di Cardiologia 1999;29(12):1472‐7. - PubMed
    1. Girolamo E, Iorio C, Sabatini P, Leonzio L, Barbone C, Barsotti A. Effects of paroxetine hydrochloride, a selective serotonin reuptake inhibitor, on refractory vasovagal syncope: a randomized, double‐blind, placebo‐controlled study. Journal of the American College of Cardiology 1999;33(5):1227‐30. - PubMed
El‐Bedawi 1994 {published data only}
    1. El‐Bedawi KM, Wahbha MA, Hainsworth R. Cardiac pacing does not improve orthostatic tolerance in patients with vasovagal syncope. Clinical Autonomic Research 1994;4(5):233‐7. - PubMed
Eldadah 2006 {published data only}
    1. Eldadah BA, Pechnik SL, Holmes CS, Moak JP, Saleem AM, Goldstein DS. Failure of propranolol to prevent tilt‐evoked systemic vasodilatation, adrenaline release and neurocardiogenic syncope. Clinical Science 2006;111(3):209‐16. - PubMed
Flammang 1999 {published data only}
    1. Flammang D, Antiel M, Church T, Chassing A, Hamani D, Donal E, et al. Is a pacemaker indicated for vasovagal patients with severe cardioinhibitory reflex as identified by the ATP test? A preliminary randomized trial. Europace. 1999;1(2):140‐5. - PubMed
Flevari 2002 {published data only}
    1. Flevari P, Livanis EG, Theodorakis GN, Zarvalis E, Mesiskli T, Kremastinos DT. Vasovagal syncope: a prospective, randomized, crossover evaluation of the effect of propranolol, nadolol and placebo on syncope recurrence and patients' well‐being. Journal of the American College of Cardiology 2002;40(3):499‐504. - PubMed
Guan 1999 {published data only}
    1. Guan Wu, Liu ZH, Chen DM, Huang XP. Control study on treatment of vasovagal syncope by a few drugs. Chinese Journal of Practical Internal Medicine 1999;19(11):678‐9.
Haghjoo 2006 {published data only}
    1. Haghjoo M, Zameni MA, Fazelifar AF, Alizadeh A, Sadr‐Ameli MA. A randomized trial of oral propranolol versus metoprolol in treatment of neurally mediated syncope. Indian Heart Journal 2006;58(6):426‐31. - PubMed
Jhamb 1996 {published data only}
    1. Jhamb DK, Singh B, Sharda B, Kaul U, Goel P, Talwar KK, et al. Comparative study of the efficacy of metoprolol and verapamil in patients with syncope and positive head‐up tilt test response. American Heart Journal 1996;132(3):608‐11. - PubMed
Kaufmann 2002 {published data only}
    1. Kaufmann H, Saadia D, Voustianiouk A. Midodrine in neurally mediated syncope: a double‐blind, randomized, crossover study. Annals of Neurology 2002;52(3):342‐5. - PubMed
Kenny 2001 {published data only}
    1. Kenny RA, Richardson DA, Steen N, Bexton RS, Shaw FE, Bond J. Carotid sinus syndrome: a modifiable risk factor for nonaccidental falls in older adults (SAFE PACE). Journal of the American College of Cardiology 2001;38(5):1491‐6. - PubMed
Kluger 1998 {published data only}
    1. Kluger J, Bazunga M, Goldman R, O'Rangers E, Azar P, Chow MS. Usefulness of intravenous metoprolol to prevent syncope induced by head‐up tilt. American Journal of Cardiology 1998;82(6):820‐3, A10. - PubMed
Kurbaan 2000a {published data only}
    1. Kurbaan AS, Franzen AC, Stack Z, Heaven D, Mathur G, Sutton R. Determining the optimal pacing intervention rate for vasovagal syncope. Journal of Interventional Cardiac Electrophysiology 2000;4(4):585‐9. - PubMed
Lee 1996 {published data only}
    1. Lee TM, Su SF, Chen MF, Liau CS, Lee YT. Usefulness of transdermal scopolamine for vasovagal syncope. American Journal of Cardiology 1996;78(4):480‐2. - PubMed
Lin 2000 {published data only}
    1. Lin WH, Ren ZW, Ding YS, Yang JJ. A study on the effect of oral atenolol or enalaprol for vasovagal syncope. Chinese Journal of Interventional Cardiology 2000;8(4):171‐3.
Madrid 2001 {published data only}
    1. Madrid AH, Ortega J, Rebollo JG, Manzano JG, Segovia JG, Sanchez A, et al. Lack of efficacy of atenolol for the prevention of neurally mediated syncope in a highly symptomatic population: a prospective, double‐blind, randomized and placebo‐controlled study. Journal of the American College of Cardiology 2001;37(2):554‐9. - PubMed
Mahanonda 1995 {published data only}
    1. Mahanonda N, Bhuripanyo K, Kangkagate C, Wansanit K, Kulchot B, Nademanee K, et al. Randomized double‐blind, placebo‐controlled trial of oral atenolol in patients with unexplained syncope and positive upright tilt table test results. American Heart Journal 1995;130(6):1250‐3. - PubMed
McIntosh 1997 {published data only}
    1. McIntosh SJ, Lawson J, Bexton RS, Gold RG, Tynan MM, Kenny RA. A study comparing VVI and DDI pacing in elderly patients with carotid sinus syndrome. Heart 1997;77(6):553‐7. - PMC - PubMed
Moore 2005 {published data only}
    1. Moore A, Watts M, Sheehy T, Hartnett A, Clinch D, Lyons D. Treatment of vasodepressor carotid sinus syndrome with midodrine: a randomized, controlled pilot study. Journal of the American Geriatrics Society 2005;53(1):114‐8. - PubMed
Morillo 1993 {published data only}
    1. Morillo CA, 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. Journal of the American College of Cardiology 1993;22(7):1843‐8. - PubMed
Moya 1995 {published data only}
    1. Moya A, Permanyer‐Miralda G, Sagrista‐Sauleda J, Carne X, Rius T, Mont L, et al. Limitations of head‐up tilt test for evaluating the efficacy of therapeutic interventions in patients with vasovagal syncope: results of a controlled study of etilefrine versus placebo. Journal of the American College of Cardiology 1995;25(1):65‐9. - PubMed
    1. Moya A, Sagristà J, Permanyer MG, Rius T, Mont L, Romero B, et al. Role of Tilt table test in the assessment of the treatment for vasovagal syncope. Results from a randomized study with etilefrine. Annals de Medicina 1994;80:31.
Nakagawa 1998 {published data only}
    1. Nakagawa H, Kobayashi Y, Kikushima S, Shinohara M, Obara C, Zinbo Y, et al. Long‐term effects of pharmacological therapy for vasovagal syncope on the basis of reproducibility during head‐up tilt testing. Japanese Circulation Journal 1998;62(10):727‐32. - PubMed
Occhetta 2004 {published data only}
    1. Occhetta E, Bortnik M, Audoglio R, Vassanelli C. Closed loop stimulation in prevention of vasovagal syncope. INotropy controlled pacing in VAsovagal SYncope (INVASY): a multicentre randomized, single blind, controlled study. Europace 2004;6(6):538‐47. - PubMed
Perez‐Lugones 2001 {published data only}
    1. Perez‐Lugones A, Schweikert R, Pavia S, Sra J, Akhtar M, Jaeger F, et al. Usefulness of midodrine in patients with severely symptomatic neurocardiogenic syncope: a randomized control study. Journal of Cardiovascular Electrophysiology 2001;12(8):935‐8. - PubMed
Raviele 1999 {published data only}
    1. Alboni P, Brignole M, Giani P, Menozzi C, Moya A, Raviele A, et al. Double‐blind randomised study etilefrine versus placebo in patients with tilt‐induced recurrent vasovagal syncope. European Journal of Cardiac Pacing and Electrophysiology 1993;3(2):164‐8.
    1. Raviele A, Brignole M, Sutton R, Alboni P, Giani P, Menozzi C, et al. Effect of etilefrine in preventing syncopal recurrence in patients with vasovagal syncope: a double‐blind, randomized, placebo‐controlled trial. The Vasovagal Syncope International Study. Circulation 1999;99(11):1452‐7. - PubMed
Raviele 2004 {published data only}
    1. Raviele A, Giada F, Menozzi C, Speca G, Orazi S, Gasparini G, et al. A randomized, double‐blind, placebo‐controlled study of permanent cardiac pacing for the treatment of recurrent tilt‐induced vasovagal syncope. The vasovagal syncope and pacing trial (SYNPACE). European Heart Journal 2004;25(19):1741‐8. - PubMed
    1. Raviele A, Giada F, Sutton R, Alboni P, Brignole M, Rosso A, et al. The vasovagal Syncope and pacing (Synpace) trial: rationale and study design. Europace. 2001;3(4):336‐41. - PubMed
Raviele 2005 {published data only}
    1. Raviele A, Giada F, Gasparini G. Efficacy of a patient‐activated pharmacologic pump using phenylephrine as active drug and prodromal symptoms as a marker of imminent loss of consciousness to abort tilt‐induced syncope. Journal of the American College of Cardiology 2005;45(2):320‐1. - PubMed
Santini 1999 {published data only}
    1. Santini M, Ammirati F, Colivicchi F, Gentilucci G, Guido V. The effect of atropine in vasovagal syncope induced by head‐up tilt testing. European Heart Journal 1999;20:1745‐51. - PubMed
Sheldon 2006 {published data only}
    1. Sheldon R, Connolly S, Rose S, Klingenheben T, Krahn A, Morillo C, et al. Prevention of Syncope Trial (POST): a randomized, placebo‐controlled study of metoprolol in the prevention of vasovagal syncope. Circulation 2006;113(9):1164‐70. - PubMed
    1. Sheldon R, Rose S, Connolly S. Prevention of Syncope Trial (POST): a randomized clinical trial of beta blockers in the prevention of vasovagal syncope; rationale and study design. Europace 2003;5(1):71‐5. - PubMed
Sutton 2000 {published data only}
    1. Sutton R, Brignole M, Menozzi C, Raviele A, Alboni P, Giani P, et al. Dual‐chamber pacing in the treatment of neurally mediated tilt‐positive cardioinhibitory syncope : pacemaker versus no therapy: a multicenter randomized study. The Vasovagal Syncope International Study (VASIS) Investigators. Circulation 2000;102(3):294‐9. - PubMed
    1. Vasovagal Syncope International Study Investigators. Is dual‐chamber pacing efficacious in treatment of neurally‐mediated tilt positive cardioinhibitory syncope. Pacemaker vs no therapy: A multicentre randomised study. European Journal of Cardiac Pacing and Electrophysiology 1993;3:169‐72.
Theodorakis 2006 {published data only}
    1. Theodorakis GN, Leftheriotis D, Livanis EG, Flevari P, Karabela G, Aggelopoulou N, et al. Fluoxetine vs propranolol in the treatment of vasovagal syncope: a prospective, randomized, placebo‐controlled study. Europace 2006;8(3):193‐8. - PubMed
Ventura 2002 {published data only}
    1. Ventura R, Maas R, Zeidler D, Schoder V, Nienaber CA, Schuchert A, et al. A randomized and controlled pilot trial of beta‐blockers for the treatment of recurrent syncope in patients with a positive or negative response to head‐up tilt test. Pacing and Clinical Electrophysiology 2002;25(5):816‐21. - PubMed
Ward 1998 {published data only}
    1. Ward CR, Gray JC, Gilroy JJ, Kenny RA. Midodrine: a role in the management of neurocardiogenic syncope. Heart 1998;79(1):45‐9. - PMC - PubMed
Zeng 1998a {published data only}
    1. Zeng CY, Zhu Z, Liu G, Wang X, He D, Wang H, et al. Inhibitory effect of enalapril on neurally mediated syncope in elderly patients. Journal of Cardiovascular Pharmacology 1998;31(4):638‐42. - PubMed
Zeng 1998b {published data only}
    1. Zeng C, Zhu Z, Liu G, Hu W, Wang X, Yang C, et al. Randomized, double‐blind, placebo‐controlled trial of oral enalapril in patients with neurally mediated syncope. American Heart Journal 1998;136(5):852‐8. - PubMed
    1. Zeng CY, Liu GY, Wang XK, Wang HY, Yang CM, He DF. Effects of oral enalapril on neurally mediated syncope. The Chinese Journal of Clinical Pharmacology 1998;14:137‐40.

References to studies excluded from this review

Ahmed 1991 {published data only}
    1. Ahmed R, Cuneri S, Ingram A, Chan SL, Travill CM, Sutton R. Double blind comparison of DDI, DDI with rate hysteresis, VVI and VVI with rate hysteresis in symptom control in carotid sinus syndrome. Pacing and Clinical Electrophysiology 1991;14(Part 2):623.
Alboni 1993 {published data only}
    1. Alboni P. Double‐blind randomised study etilefrine versus placebo. In patients with tilt‐induced recurrent vasovagal syncope. European Journal of Cardiac Pacing and Electrophysiology 1993;3:164‐8.
Bottero 1990 {published data only}
    1. Bottero M, Mosele GM, Ometto R, Finocchi G, Vincenzi M. Carotid sinus hypersensitivity (CSH): electrophysiologically guided PM selection and long term follow up results. New Trends in Arrhythmias 1990;6(1‐2):119‐21.
Bottoni 2003 {published data only}
    1. Bottoni N, Menozzi C, Brignole M. Management of patients with recurrent neuromediated syncope. Mediterranean Journal of Pacing and Electrophysiology 2003;5(2):73‐6.
Brignole 2006a {published data only}
    1. Brignole M, Sutton R, Menozzi C, Garcia‐Civera R, Moya A, Wieling W, et al. Early application of an implantable loop recorder allows effective specific therapy in patients with recurrent suspected neurally mediated syncope. European Heart Journal 2006;27(9):1085‐92. - PubMed
Carlioz 1999 {published data only}
    1. Carlioz R, Burlaton J‐P. Medical treatment of vasovagal syncopes. Archives des Maladies du Coeur et des Vaisseaux ‐ Pratique 1999;81:9.
Christian 1973 {published data only}
    1. Christian N, Schwartz H. Treatment of carotid sinus syncope with demand pacemaker. Geriatrics 1973;28(2):131‐3. - PubMed
Deharo 1999 {published data only}
    1. Deharo J‐C. Permanent cardiac pacing and vasovagal syncope. Archives des Maladies du Coeur et des Vaisseaux ‐ Pratique 1999;81:11.
Deharo 2002 {published data only}
    1. Deharo J‐C. Role of cardiac pacing in the treatment of vasovagal syncope. Policlinico ‐ Sezione Medica 2002;109(2):58‐61.
De Naro 1998 {published data only}
    1. Naro J‐C. New pacing approach to neurocardiogenic syncope. European Journal of Cardiac Pacing and Electrophysiology 1998;8(1):34‐5.
Elder 1992 {published data only}
    1. Elder CA, Spinler SA. Upright tilt‐table testing and drug therapy for recurrent vasovagal syncope. Annals of Pharmacotherapy 1992;26(6):786‐8. - PubMed
Gadermann 1973 {published data only}
    1. Gadermann E, Heinz N, Saegler J. Syncope in the carotid sinus syndrome and its treatment. Internist 1973;14(10):502‐10. - PubMed
Garcia‐Alberola 2002 {published data only}
    1. Garcia‐Alberola A, Lacunza J, Sanchez JJ, Martinez‐Sanchez J, Llamas C, Valdes M. Atenolol and Bisoprolol have different effects on the results of head‐up tilt test in patients with vasovagal syncope. Pacing & Clinical Electrophysiology: Naspe Abstracts 2002;24(Part 2):609.
Griebenow 1991 {published data only}
    1. Griebenow R, Kramer L, Bartels S. Therapeutic decisions in carotid sinus syndrome. Pacing and Clinical Electrophysiology 1991;14(Part 2):692.
Grubb 2000 {published data only}
    1. Grubb BP. SSRIs for vasodepressor syncope?. Postgraduate Medicine 2000;108(6):29, 32. - PubMed
Gusak 1998 {published data only}
    1. Gusak VK, Dziugan' SA, Kuznetsov AS, Kharitonchik DL, Onishchak OD. The carotid sinus syndrome: problems and outlook. Klinichna Khirurhiia 1998;11:39‐41. - PubMed
Hacker 1972 {published data only}
    1. Hacker RW, Haasis R, Dittrich H. Pacemaker therapy in the spontaneous vagal‐cardiac hypersensitive carotid sinus syndrome. Medizinische Welt 1972;23(52):1971‐3. - PubMed
Kenny 1999a {published data only}
    1. Daniel JR, Steen N, Seifer MC, Kenny R. Carotid sinus syndrome, should we pace? A multi‐centre, randomised control trial (Safepace 2). Heart 2010;96(5):347‐51. - PubMed
    1. Kenny RA. SAFE PACE 2: Syncope and Falls in the Elderly‐‐Pacing and Carotid Sinus Evaluation: a randomized controlled trial of cardiac pacing in older patients with falls and carotid sinus hypersensitivity. Europace 1999;1(1):69‐72. - PubMed
    1. Kenny RA, Seifer C. Brief Report ‐ SAFE PACE 2 Syncope And Falls in the Elderly Pacing And Carotid Sinus Evaluation: a randomized control trial of cardiac pacing in older patients with falls and carotid sinus hypersensitivity. American Journal of Geriatric Cardiology 1999;8(2):87. - PubMed
Kenny 1999b {published data only}
    1. Daniel JR, Steen N, Seifer MC, Kenny R. Carotid sinus syndrome, should we pace? A multi‐centre, randomised control trial (Safepace 2). Heart 2010;96(5):347‐51. - PubMed
    1. Kenny RA. SAFE PACE 2: Syncope and Falls in the Elderly‐‐Pacing and Carotid Sinus Evaluation: a randomized controlled trial of cardiac pacing in older patients with falls and carotid sinus hypersensitivity. Europace 1999;1(1):69‐72. - PubMed
    1. Kenny RA, Seifer C. Brief Report ‐ SAFE PACE 2 Syncope And Falls in the Elderly Pacing And Carotid Sinus Evaluation: a randomized control trial of cardiac pacing in older patients with falls and carotid sinus hypersensitivity. American Journal of Geriatric Cardiology 1999;8(2):87. - PubMed
Kuchinskaia 2006 {published data only}
    1. Kuchinskaia EA, Pevzner AV, Vershuta EV, Al'bitskaia KV, Kheimets GI, Rogoza AN, et al. Comparative efficacy and tolerance of atenolol and midodrine in patients with vasovagal syncopes. Terapevticheski Arkhiv 2006;78(4):64‐8. - PubMed
Kurbaan 2000b {published data only}
    1. Kurbaan AS, Sutton R. Vasovagal syncope: the role of cardiac pacing. British Journal of Cardiology 2000;7(1):24‐5+28.
Lagi 1997 {published data only}
    1. Lagi A, Colzi L, Tamburini C. Vaso‐vagal syncope and supply of salt. Cerebrovascular Diseases 1997;7(5):299‐300.
Lippman 1994 {published data only}
    1. Lippman N, Stein KM, Lerman BB. Differential therapeutic responses of patients with isoproterenol‐dependent and isoproterenol‐independent vasodepressor syncope. American Heart Journal 1994;128(6 Pt 1):1110‐6. - PubMed
Lopez 1993 {published data only}
    1. Lopez Candel J, Pico Aracil F, Sanchez Munoz JJ, Morena G, Martinez Sanchez J, Salas J, et al. Malignant vasovagal syncope: its diagnosis and therapeutic trial based on the orthostatism test (the tilt‐table test). Revista Espanola de Cardiologia 1993;46(1):28‐33. - PubMed
Morley 1983 {published data only}
    1. Morley CA, Perrins EJ, Chan SL, Sutton R. A randomised controlled trial of DVI and VVI pacing in the carotid sinus syndrome. Pacing and Clinical Electrophysiology 1999;6:A‐20. - PubMed
Murray 1970 {published data only}
    1. Murray RH, Shropshire S. Effect of atropine on circulatory responses to lower body negative pressure and vasodepressor syncope. Aerospace Medicine 1970;41:717‐22. - PubMed
Ortega 1999 {published data only}
    1. Ortega J, Madrid AH, Seara JG, Gonzalez‐Rebollo JM, Lozano F, Parra J, et al. Efficacy of intravenous atenolol for prevention of neurally mediated syncope induced by head‐up tilt testing. Annals of Noninvasive Electrocardiology 1999;4:130‐6.
Perez‐Paredes 1995 {published data only}
    1. Perez‐Paredes M, Pico Aracil F, Ruiperez Abizanda JA, Martinez Sanchez J, Florenciano Sanchez R, Ruiz Martinez F, et al. Use of transdermal scopolamine in the prevention of neuro‐cardiogenic syncope induced by the tilt test. Revista Espanola de Cardiologia 1995;48(7):480‐5. - PubMed
Ramirez 1973 {published data only}
    1. Ramirez A. Demand pacemaker for the treatment of carotid sinus syncope. Journal of Thoracic and Cardiovascular Surgery 1973;66(2):287‐9. - PubMed
Richardson 2000 {published data only}
    1. Richardson DA, Steen N, Bond J, Bexton RS, Kenny RA. Cardiac pacing reduces falls in carotid sinus hypersensitivity. Age and Ageing 2000;29(Suppl 1):46.
Schneller 1985 {published data only}
    1. Schneller SJ, Harthorne J. Carotid sinus hypersensitivity. Clinical Progress in Electrophysiology and Pacing 1985;3(6):389‐402.
Schranz 1981 {published data only}
    1. Schranz W. Syncopal attacks. Fortschritte der Medizin 1981;99(4):92‐5. - PubMed
Stein 1994 {published data only}
    1. Stein KM, Lippman N, Engelstein ED, Lerman BB. Comparative efficacy of atenolol and guanfacine in the treatment of vasodepressor syncope. PACE. Abstract session 5: vasovagal syncope/tilt table testing 1994;17(Part 2):747.
Strauer 1973 {published data only}
    1. Strauer BE, Brunner L, Dehne N. Treatment of carotid sinus syndrome with cardiac pacemaker stimulation. Deutsche Medizinische Wochenschrift 1973;98(11):558‐60. - PubMed
Takata 2002 {published data only}
    1. Takata TS, Wasmund SL, Smith ML, Li JM, Joglar JA, Banks K, et al. Serotonin reuptake inhibitor (Paxil) does not prevent the vasovagal reaction associated with carotid sinus massage and/or lower body negative pressure in healthy volunteers. Circulation 2002;106(12):1500‐4. - PubMed
Von Lehe 1971 {published data only}
    1. Lehe DP. Carotid sinus syncope treated with demand pacemaker. Journal of the South Carolina Medical Association 1971;67(1):7‐9. - PubMed
Williamson 1994 {published data only}
    1. Williamson BD, Strickberger SA, Man KC, Hummel JD, Morady F. A randomized trial of sertraline versus atenolol and disopyramide in the treatment of neurogenic syncope. Pacing and Clinical Electrophysiology. Abstract session 5: vasovagal syncope/tilt table testing 1994;17(4 Part 2):747.
Wittig 1998 {published data only}
    1. Wittig K, Meyer C, Neugebauer A, Pfeiffer D. Results of tilt‐table testing in patients with syncope ‐ Indication of biventricular pacemaker implantation as therapeutic option. Herzschrittmachertherapie und Elektrophysiologie 1998;9(SUPPL.1):19‐21. - PubMed
Wolff 1956 {published data only}
    1. Wolff H. The treatment of cerebral seizures with scopolamine; clinical aspects of the syncopal syndrome. Deutsche Medizinische Wochenschrift 1956;81(34):1358‐60. - PubMed

References to studies awaiting assessment

Ammirati 1999 {published data only}
    1. Ammirati F, Colivicchi F, Guido V, Gentilucci G, Santini M. Etilefrin efficacy in the neurally‐mediated syncope induced by tilt test. Giornale Italiano di Cardiologia 1999;29:106.
Betsuyaku 1995 {published data only}
    1. Betsuyaku T, Takano H, Hirao N, Nakano N, Kobayashi T, Yotsukura A, et al. Efficacy of metoprolol and disopyramide on neurally mediated syncope. Respiration and Circulation 1995;43(1):61‐4.
Elstermann 1981 {published data only}
    1. Elstermann Von Elster FW, Berntsen AL, Boehle E. Carotid sinus syndrome: Pacemaker and medical treatment. Zeitschrift für Kardiologie 1981;70(4):106.
Ventura 2001 {published data only}
    1. Ventura R, Maas R, Zeidler D, Frost G, Weiss C, Willems S. Predictive value of the tilt table test for predicting efficacy of a beta‐blocker therapy in patients with recurring vasovagal syncopes. Zeitschrift für Kardiologie 2001;90:54.

References to ongoing studies

Brignole 2007 {published data only}
    1. Brignole M. International study on syncope of uncertain aetiology 3 (ISSUE 3): pacemaker therapy for patients with asystolic neurally‐mediated syncope: rationale and study design. Europace 2007;9(1):25‐30. - PubMed
Raj 2006 {published data only}
    1. Raj SR, Rose S, Ritchie D, Sheldon RS. The Second Prevention of Syncope Trial (POST II)‐‐a randomized clinical trial of fludrocortisone for the prevention of neurally mediated syncope: rationale and study design. American Heart Journal 2006;151(6):1186‐7. - PubMed
STAND {unpublished data only}
    1. ISRCTN29932893. Treatment strategy in patients with recurrent vasovagal syncope: STAND (Syncope Treatment Association Netherlands Danmark). http://www.controlled‐trials.com/isrctn/pf/29932893 (accessed 1 May 2009).

Additional references

Alboni 2002
    1. Alboni P, Dinelli M, Gruppillo P, Bondanelli M, Bettiol K, Marchi P, et al. Haemodynamic changes early in prodromal symptoms of vasovagal syncope. Europace 2002;4(3):333‐8. - PubMed
Altman 2008
    1. Altman D, Antes G, Gøtzsche PC, Higgins J, Jüni P, Lewis S, et al. 8. Assessing risk of bias in included studies. In: Higgins JP, Altman DG editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Collaboration, 2008:i‐53.
Benditt 1999
    1. Benditt DG, Fahy GJ, Lurie KG, Sakaguchi S, Fabian W, Samniah N. Pharmacotherapy of neurally mediated syncope. Circulation 1999;100(11):1242‐8. - PubMed
Bernstein 2002
    1. Bernstein AD, Daubert JC, Fletcher RD, Hayes DL, Luderitz B, Reynolds DW, et al. The revised NASPE/BPEG generic code for antibradycardia, adaptive‐rate, and multisite pacing. North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group. Pacing and Clinical Electrophysiology 2002;25(2):260‐4. - PubMed
Blanc 1993
    1. Blanc JJ, Mansourati J, Maheu B, Boughaleb D, Genet L. Reproducibility of a positive passive upright tilt test at a seven‐day interval in patients with syncope. American Journal of Cardiology 1993;72(5):469‐71. - PubMed
Brignole 2004
    1. Brignole M, Alboni P, Benditt DG, Bergfeldt L, Blanc JJ, Bloch Thomsen PE, et al. Guidelines on management (diagnosis and treatment) of syncope‐‐update 2004. Europace 2004;6(6):467‐537. - PubMed
Brignole 2006b
    1. Brignole M, Sutton R, Menozzi C, Garcia‐Civera R, Moya A, Wieling W, et al. International Study on Syncope of Uncertain Etiology 2 (ISSUE 2) Group. Lack of correlation between the responses to tilt testing and adenosine triphosphate test and the mechanism of spontaneous neurally mediated syncope. European Heart Journal 2006;27(18):2232‐9. - PubMed
Brooks 1993
    1. Brooks R, Ruskin JN, Powell AC, Newell J, Garan H, McGovern BA. Prospective evaluation of day‐to‐day reproducibility of upright tilt‐table testing in unexplained syncope. American Journal of Cardiology 1993;71(15):1289‐92. - PubMed
Calkins 1999
    1. Calkins H. Pharmacologic approaches to therapy for vasovagal syncope. American Journal of Cardiology 1999;84(8A):20Q‐5Q. - PubMed
Cochrane 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
College 2009
    1. College voor Zorgverzekeringen. Farmacotherapeutic Compass [Farmacotherapeutisch Kompas]. www.fk.cvz.nl (accessed 23 March 2009).
Colman 2004
    1. Colman N, Nahm K, Ganzeboom KS, Shen WK, Reitsma J, Linzer M, et al. Epidemiology of reflex syncope. Clinical Autonomic Research 2004;14(Suppl 1):9‐17. - PubMed
Curtin 2002a
    1. Curtin F, Elbourne D, Altman DG. Meta‐analysis combining parallel and cross‐over clinical trials. II: binary outcomes. Statistics in Medicine 2002;21(15):2145‐59. - PubMed
Curtin 2002b
    1. Curtin F, Altman DG, Elbourne D. Meta‐analysis combining parallel and cross‐over clinical trials. I: continuous outcomes. Statistics in Medicine 2002;21(15):2131‐44. - PubMed
Deniz 2008
    1. Deniz HB, Caro JJ, Ward A, Moller J, Malik F. Economic and health consequences of managing bradycardia with dual‐chamber compared to single‐chamber ventricular pacemakers in Italy. Journal of Cardiovascular Medicine 2008;9(1):43‐50. - PubMed
Ector 1998
    1. Ector H, Reybrouck T, Heidbuchel H, Gewillig M, Werf F. Tilt training: a new treatment for recurrent neurocardiogenic syncope and severe orthostatic intolerance. Pacing and Clinical Electrophysiology 1998;21(1 Pt 2):193‐6. - PubMed
el‐Sayed 1996
    1. el‐Sayed H, Hainsworth R. Salt supplement increases plasma volume and orthostatic tolerance in patients with unexplained syncope. Heart 1996;75(2):134‐40. - PMC - PubMed
Elbourne 2002
    1. Elbourne DR, Altman DG, Higgins JP, Curtin F, Worthington HV, Vail A. Meta‐analyses involving cross‐over trials: methodological issues. International Journal of Epidemiology 2002;31(1):140‐9. - PubMed
Foglia‐Manzillo 2004
    1. Foglia‐Manzillo G, Giada F, Gaggioli G, Bartoletti A, Lolli G, Dinelli M, et al. Efficacy of tilt training in the treatment of neurally mediated syncope. A randomized study. Europace 2004;6(3):199‐204. - PubMed
Ganzeboom 2003
    1. Ganzeboom KS, Colman N, Reitsma JB, Shen WK, Wieling W. Prevalence and triggers of syncope in medical students. American Journal of Cardiology 2003;91(8):1006‐8. - PubMed
Ganzeboom 2006
    1. Ganzeboom KS, Mairuhu G, Reitsma JB, Linzer M, Wieling W, Dijk N. Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35‐60 years. Journal of Cardiovascular Electrophysiology 2006;17(11):1172‐6. - PubMed
Gurevitz 2007
    1. Gurevitz O, Barsheshet A, Bar‐Lev D, Zimlichman E, Rosenfeld GF, Benderly M, et al. Tilt training: does it have a role in preventing vasovagal syncope?. Pacing and Clinical Electrophysiology 2007;30(12):1499‐505. - PubMed
Healey 2004
    1. Healey J, Connolly SJ, Morillo CA. The management of patients with carotid sinus syndrome: is pacing the answer?. Clinical Autonomic Research 2004;14(Suppl 1):80‐6. - PubMed
Helke 1993
    1. Helke CJ, McDonald CH, Phillips ET. Hypotensive effects of 5‐HT1A receptor activation: ventral medullary sites and mechanisms of action in the rat. Journal of the Autonomic Nervous System 1993;42(2):177‐88. - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. - PMC - PubMed
Hussain 1996
    1. Hussain RM, McIntosh SJ, Lawson J, Kenny RA. Fludrocortisone in the treatment of hypotensive disorders in the elderly. Heart 1996;76(6):507‐9. - PMC - PubMed
Kaufmann 2004
    1. Kaufmann H, Freeman R. Pharmacological treatment of reflex syncope. Clinical Autonomic Research 2004;14(Suppl 1):71‐5. - PubMed
Kuriachan 2008
    1. Kuriachan V, Sheldon RS, Platonov M. Evidence‐based treatment for vasovagal syncope. Heart Rhythm 2008;5(11):1609‐14. - PubMed
Linzer 1991
    1. Linzer M, Pontinen M, Gold DT, Divine GW, Felder A, Brooks WB. Impairment of physical and psychosocial function in recurrent syncope. Journal of Clinical Epidemiology 1991;44(10):1037‐43. - PubMed
Linzer 1997
    1. Linzer M, Yang EH, Estes NA III, Wang P, Vorperian VR, Kapoor WN. Diagnosing syncope. Part 1: Value of history, physical examination, and electrocardiography. Clinical Efficacy Assessment Project of the American College of Physicians. Annals of Internal Medicine 1997;126(12):989‐96. - PubMed
Majewski 1984
    1. Majewski H, Hedler L, Schurr C, Starke K. Modulation of noradrenaline release in the pithed rabbit: a role for angiotensin II. Journal of Cardiovascular Pharmacology 1984;6(5):888‐96. - PubMed
McLaran 1986
    1. McLaran CJ, Gersh BJ, Osborn MJ, Wood DL, Sugrue DD, Holmes DR Jr, et al. Increased vagal tone as an isolated finding in patients undergoing electrophysiological testing for recurrent syncope: response to long term anticholinergic agents. British Heart Journal 1986;55(1):53‐7. - PMC - PubMed
Moher 1999
    1. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta‐analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta‐analyses. Lancet 1999;354(9193):1896‐900. - PubMed
Morgan 1988
    1. Morgan DA, Thoren P, Wilczynski EA, Victor RG, Mark AL. Serotonergic mechanisms mediate renal sympathoinhibition during severe hemorrhage in rats. American Journal of Physiology 1988;255(3 Pt 2):H496‐502. - PubMed
Moya 2009
    1. Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB, et al. Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). European Heart Journal 2009;30(21):2631‐71. - PMC - PubMed
Rose 2000
    1. Rose MS, Koshman ML, Spreng S, Sheldon R. The relationship between health‐related quality of life and frequency of spells in patients with syncope. Journal of Clinical Epidemiology 2000;53(12):1209‐16. - PubMed
Salim 2005
    1. Salim MA, Sessa TG. Effectiveness of fludrocortisone and salt in preventing syncope recurrence in children: a double‐blind, placebo‐controlled, randomized trial. Journal of the American College of Cardiology 2005;45(4):484‐8. - PubMed
Samoil 1995
    1. Samoil D, Grubb BP. Neurally mediated syncope and serotonin reuptake inhibitors. Clinical Autonomic Research 1995;5(5):251‐5. - PubMed
Sheldon 1992
    1. Sheldon R, Splawinski J, Killam S. Reproducibility of isoproterenol tilt‐table tests in patients with syncope. American Journal of Cardiology 1992;69(16):1300‐5. - PubMed
Sheldon 2007
    1. Sheldon RS, Sheldon AG, Serletis A, Connolly SJ, Morillo CA, Klingenheben T, et al. Worsening of symptoms before presentation with vasovagal syncope. Journal of Cardiovascular Electrophysiology 2007;18(9):954‐9. - PubMed
Soteriades 2002
    1. Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ, et al. Incidence and prognosis of syncope. New England Journal of Medicine 2002;347(12):878‐85. - PubMed
Sud 2007
    1. Sud S, Massel D, Klein GJ, Leong‐Sit P, Yee R, Skanes AC, et al. The expectation effect and cardiac pacing for refractory vasovagal syncope. American Journal of Medicine 2007;120(1):54‐62. - PubMed
Tierney 2007
    1. Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time‐to‐event data into meta‐analysis. Trials 2007;8:16. - PMC - PubMed
Van Dijk 2006a
    1. Dijk N, Sprangers MA, Colman N, Boer KR, Wieling W, Linzer M. Clinical factors associated with quality of life in patients with transient loss of consciousness. Journal of Cardiovascular Electrophysiology 2006;17(9):998‐1003. - PubMed
Van Dijk 2006b
    1. Dijk N, Quartieri F, Blanc JJ, Garcia‐Civera R, Brignole M, Moya A, et al. Effectiveness of physical counterpressure maneuvers in preventing vasovagal syncope: the Physical Counterpressure Manoeuvres Trial (PC‐Trial). Journal of the American College of Cardiology 2006;48(8):1652‐7. - PubMed
Van Dijk 2007
    1. Dijk N, Sprangers MA, Boer KR, Colman N, Wieling W, Linzer M. Quality of life within one year following presentation after transient loss of consciousness. American Journal of Cardiology 2007;100(4):672‐6. - PubMed
Van Dijk 2008
    1. Dijk N, Boer KR, Colman N, Bakker A, Stam J, Grieken JJ, et al. High diagnostic yield and accuracy of history, physical examination, and ECG in patients with transient loss of consciousness in FAST: the Fainting Assessment study. Journal of Cardiovascular Electrophysiology 2008;19(1):48‐55. - PubMed
Ward 1995
    1. Ward C, Kenny RA. Observations on midodrine in a case of vasodepressor neurogenic syncope. Clinical Autonomic Research 1995;5(5):257‐60. - PubMed
Wieling 2004
    1. Wieling W, Colman N, Krediet CT, Freeman R. Nonpharmacological treatment of reflex syncope. Clinical Autonomic Research 2004;14(Suppl 1):62‐70. - PubMed
Zeng 1998
    1. Zeng CY, Zhu Z, Liu G, Wang X, He D, Wang H, et al. Inhibitory effect of enalapril on neurally mediated syncope in elderly patients. Journal of Cardiovascular Pharmacology 1998;31(4):638‐42. - PubMed

LinkOut - more resources