THE ROLE OF SEROTONIN REUPTAKE INHIBITORS IN PREVENTING RECURRENT UNEXPLAINED CHILDHOOD SYNCOPE - A PRELIMINARY-REPORT

To assess the efficacy of a serotonin re-uptake inhibitor, sertraline hydrochloride, in preventing recurrent neurocardiogenic syncope, we st udied 15 patients (10 female; mean age 12.9 +/- 2 years) with positive head-upright tilt test and resistant to standard pharmacotherapy, ate nolol or disopyramide. The patients were given 50 mg oral sertraline h ydrochloride daily for 6 weeks. Intolerance to the drug was seen in 3 patients and 2 had syncopal episodes during the therapy. A head-uprigh t tilt table test was then repeated in 10 patients. Six were tilt nega tive and asymptomatic over a mean follow up period of 7 +/- 3 months w hile four remained tilt positive: two experienced marked hypotension a nd bradycardia, characterized as mixed type syncope, and two had cardi ac asystole, lasting > 10 s, during tilting, thereby exhibiting a card io-inhibitory response. Conclusion Sertraline hydrochloride may be use ful in preventing recurrent neurocardiogenic syncope resistant to stan dard pharmacotherapy but careful clinical studies are essential before such a treatment strategy can be recommended since serious asystole c ould develop.