EFFICACY OF DIFFERENT TREATMENT STRATEGIES FOR NEUROCARDIOGENIC SYNCOPE

Objectives: The purpose of this study was to evaluate the efficacy of different therapeutic approaches for patients with a history of syncop e and positive head-up tilt testing. Background: Head-up tilt testing has gained broad acceptance as a reliable diagnostic method for the as sessment of patients with recurrent unexplained syncope. However, once the diagnosis is established, there is no consensus on the most appro priate treatment. In this respect, efficacy of drug therapy in prevent ing recurrence of symptoms in such patients is not entirely clear, and controversies exist regarding the need to confirm the effects of phar macological interventions. Methods: Clinical follow-up was obtained in 303 patients with a history of syncope and positive head-up tilt test ing. After the diagnostic head-up tilt, patients were assigned to diff erent therapeutic approaches according to their preference or logistic impediments. Of 303 patients, 44 received empiric therapy, 210 were t reated with medications proven effective during repeated head-up tilt testing, and 49 refused or discontinued medical therapy. The three gro ups were similar with regard to age, sex, and clinical presentation Th e mean follow-up was 2.8 +/- 1.8 years. Among the patients treated acc ording to head-up tilt guided therapy, 130 were on beta blockers, 35 o n theophylline, 10 on ephedrine, 31 on disopyramide, and 4 on miscella neous regimens. Empiric treatment consisted of beta blockers in 37 of 44 patients and other drugs in the remaining patients. Results: During the follow-up, recurrence of symptoms was experienced in 12 (6%) of t he 210 patients receiving the head-up tilt guided therapy, 16 (36%) of 44 in the empiric therapy group, and 33 (67%) of 49 in the no therapy group. Recurrence of symptoms in patients on empiric or no therapy wa s significantly more frequent as compared to the head-up tilt guided t herapy group (P < 0.01). Conclusions: in patients with unexplained syn cope and positive upright tilt testing therapeutic strategies identifi ed on the basis of response during head-up tilt have a more positive i mpact on the recurrence of symptoms during follow-up.