Atomoxetine for suppression of vasovagal syncope.
Atomoxetine
Faint
Norepinephrine transport inhibition
Vasovagal syncope
Journal
Clinical autonomic research : official journal of the Clinical Autonomic Research Society
ISSN: 1619-1560
Titre abrégé: Clin Auton Res
Pays: Germany
ID NLM: 9106549
Informations de publication
Date de publication:
02 2023
02 2023
Historique:
received:
24
08
2022
accepted:
26
10
2022
pubmed:
20
11
2022
medline:
8
3
2023
entrez:
19
11
2022
Statut:
ppublish
Résumé
Vasovagal syncope (VVS) is a common clinical condition with few effective medical therapies. The study aimed to evaluate the effectiveness of atomoxetine in suppressing syncope in patients with recurrent VVS. This was a retrospective, open-label, observational case series of 12 patients taking atomoxetine for suppression of recurrent vasovagal syncope. We compared syncope frequency in the 1 year before atomoxetine and while subjects were taking atomoxetine. We used novel applications of the Poisson distribution to describe the results as a collection of n = 1 studies. There were 12 subjects, eight female, with a mean age 47 ± 22 years and a mean Calgary Syncope Symptom Score of 2 (diagnostic of vasovagal syncope). The patients received a mean dose of atomoxetine of 66 ± 16 mg (1.06 ± 0.21 mg/kg). The mean follow-up period was 1.21 ± 1.01 years. While taking atomoxetine, 11/12 patients appeared to improve and 7/12 had no syncope in follow-up (p = 0.0046). The annualized syncope frequency decreased from a median 5.5 (IQR 4, 6.75) syncope per year to 0 (IQR 0, 0.88) syncope per year (p = 0.002, Wilcoxon rank-sum test). According to the Poisson distribution, 7/12 subjects significantly improved with p values of < 0.0001 to 0.0235, 3/12 did not faint but had too brief follow-up times to detect significance, and 2/12 did not improve significantly. In this case series, atomoxetine was a promising oral agent for the prevention of vasovagal syncope. The Poisson distribution permits individual patient-level assessment of improvement and detects insufficient follow-up despite apparent improvement.
Identifiants
pubmed: 36401665
doi: 10.1007/s10286-022-00905-x
pii: 10.1007/s10286-022-00905-x
doi:
Substances chimiques
Atomoxetine Hydrochloride
57WVB6I2W0
Types de publication
Clinical Trial
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
23-28Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
Références
Ng J, Sheldon RS, Ritchie D, Raj V, Raj SR (2019) Reduced quality of life and greater psychological distress in vasovagal syncope patients compared to healthy individuals. Pacing Clin Electrophysiol 42:180–188
pubmed: 30488466
Jorge JG, Raj SR, Teixeira PS, Teixeira JAC, Sheldon RS (2021) Likelihood of injury due to vasovagal syncope: a systematic review and meta-analysis. Europace 23:1092–1099
doi: 10.1093/europace/euab041
pubmed: 33693816
Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A et al (2018) 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 39:1883–1948
doi: 10.1093/eurheartj/ehy037
pubmed: 29562304
Sheldon R, Raj SR, Rose MS, Morillo CA, Krahn AD, Medina E et al (2016) Fludrocortisone for the prevention of vasovagal syncope: a randomized placebo-controlled trial. J Am Coll Cardiol 68:1–9
doi: 10.1016/j.jacc.2016.04.030
pubmed: 27364043
Sheldon R, Faris P, Tang A, Ayala-Paredes F, Guzman J, Marquez M et al (2021) Midodrine for the prevention of vasovagal syncope : a randomized clinical trial. Ann Intern Med 174:1349–1356
doi: 10.7326/M20-5415
pubmed: 34339231
Lei LY, Raj SR, Sheldon RS (2022) Midodrine for the prevention of vasovagal syncope: a systematic review and meta-analysis. Europace 24(7):1171–1178. https://doi.org/10.1093/europace/euab323
doi: 10.1093/europace/euab323
pubmed: 35025999
pmcid: 9301979
Schomig E, Fischer P, Schonfeld CL, Trendelenburg U (1989) The extent of neuronal re-uptake of 3H-noradrenaline in isolated vasa deferentia and atria of the rat. Naunyn Schmiedebergs Arch Pharmacol 340:502–508
doi: 10.1007/BF00260604
pubmed: 2559332
Lei LY, Raj SR, Sheldon RS (2020) Pharmacological norepinephrine transporter inhibition for the prevention of vasovagal syncope in young and adult subjects: A systematic review and meta-analysis. Heart Rhythm 17:1151–1158
doi: 10.1016/j.hrthm.2020.02.033
pubmed: 32151742
pmcid: 7335357
Sheldon RS, Lei L, Guzman JC, Kus T, Ayala-Paredes FA, Angihan J et al (2019) A proof of principle study of atomoxetine for the prevention of vasovagal syncope: the Prevention of Syncope Trial VI. Europace 21:1733–1741
doi: 10.1093/europace/euz250
pubmed: 31538180
Sheldon R, Rose S, Connolly S, Ritchie D, Koshman ML, Frenneaux M (2006) Diagnostic criteria for vasovagal syncope based on a quantitative history. Eur Heart J 27:344–350
doi: 10.1093/eurheartj/ehi584
pubmed: 16223744
Kabul S, Alatorre C, Montejano LB, Farr AM, Clemow DB (2015) Real-world dosing patterns of atomoxetine in adults with attention-deficit/hyperactivity disorder. CNS Neurosci Ther 21:936–942
doi: 10.1111/cns.12442
pubmed: 26331467
pmcid: 5049605
Poisson SD (1837) Recherches sur la Probabilité des jugements en matière criminelle et en matière civile, précédées des règles générales du calcul des probabilitiés. Bachelier, Paris, France, p 206
von Bortkiewicz L. Das Gesetz der kleinen Zahlen [The law of small numbers]. Leipzig, Germany: B.G. Teubner; 1898:23.
Clarke RD (1946) An application of the Poisson distribution. J Inst Actuar 72:48
doi: 10.1017/S0020268100035435
Sahota IS, Maxey C, Pournazari P, Sheldon RS (2017) Clusters, gaps, and randomness: vasovagal syncope recurrence patterns. JACC Clin Electrophysiol 3:1046–1053
doi: 10.1016/j.jacep.2017.02.008
pubmed: 29759709
Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD et al (2017) 2017 ACC/AHA/HRS Guideline for the evaluation and management of patients with syncope: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol 70:620–663
doi: 10.1016/j.jacc.2017.03.002
pubmed: 28286222
Ruzieh M, Ghahramani M, Nudy M, Naccarelli GV, Mandrola J, Grubb BP et al (2019) The benefit of closed loop stimulation in patients with cardioinhibitory vasovagal syncope confirmed by head-up tilt table testing: a systematic review and meta-analysis. J Interv Card Electrophysiol 55:105–113
doi: 10.1007/s10840-019-00531-0
pubmed: 30863907
Sheldon RS, Ritchie D, McRae M, Raj S (2013) Norepinephrine transport inhibition for treatment of vasovagal syncope. J Cardiovasc Electrophysiol 24:799–803
doi: 10.1111/jce.12111
pubmed: 23444896
Pournazari P, Sahota I, Sheldon R (2017) High remission rates in vasovagal syncope. JACC Clin Electrophysiol 3:384–392
doi: 10.1016/j.jacep.2016.10.012
pubmed: 29759452
Sheldon R, Rose MS, Ritchie D, Martens K, Maxey C, Jagers J et al (2019) Genetic Association Study in Multigenerational Kindreds With Vasovagal Syncope. Circ Arrhythm Electrophysiol 12:e006884
doi: 10.1161/CIRCEP.118.006884
pubmed: 30636478