Age-Dependent Effect of β-Blockers in Preventing Vasovagal Syncope
Open accessAbstract
Background—: β-blockers have little effectiveness in preventing vasovagal syncope in unselected populations, but they might be effective in older patients. We determined whether β-blockers prevent vasovagal syncope in an age-related fashion. Methods and Results—: Two populations were studied. A proportional hazards analysis was performed on an observational cohort study of 153 patients with vasovagal syncope, 52 of whom received β-blockers. A multivariable proportional hazards model stratified by center was performed on 208 participants in the randomized Prevention of Syncope Trial (POST), examining the interaction between age group and treatment with metoprolol. Age-specific hazard ratios were estimated for both studies and combined using the inverse variance meta-analytic method. In the cohort study, the hazard ratio for syncope if treated with β-blockers was 1.54 (95% CI, 0.78–3.05) for patients aged <42 years and 0.48 (95% CI, 0.12–1.92) for patients aged ≥42 years. In POST, the proportional hazards model showed interactions between age and treatment effect ( P =0.026). The hazard ratio for patients aged ≥42 years who received metoprolol was 0.53 (95% CI, 0.25–1.10); in patients aged <42 years, the hazard ratio was 1.62 (95% CI, 0.85–3.10). A pooled analysis of both studies yielded an estimate of the hazard ratio of 1.58 (CI, 1.00–2.31) for patients aged <42 years, and the hazard ratio was 0.52 (CI, 0.27–1.01) for patients aged ≥42 years. The 2 age groups differed significantly in response to β-blockers ( P =0.007). Conclusions—: β-blocker treatment may suppress vasovagal syncope in middle-aged patients aged >42 years.
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In a meta-analysis of a prespecified, prestratified substudy of POST 1 and a large earlier observational study, there was evidence of benefit in patients older than 40 years.
“However, in a meta analysis of a prespecified, prestratified substudy of POST 1 and a large earlier observational study, there was evidence of benefit in patients older than 40 years.122”
From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [122]
The paper’s Abstract and Combined Populations section describe a meta-analysis of POST and an earlier observational cohort, with a pooled estimate suggesting benefit in older patients. However, the analysis used an age cutoff of ≥42 years, not older than 40; the pooled 95% confidence interval also included no effect. No page number is available in our copy. (LLM, conf=0.85)
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Cites
Moher, D., Hopewell, S., Schulz, K. F., Montori, V., Gotzsche, P. C., Devereaux, P. J., Elbourne, D., Egger, M., & Altman, D. G. (2010) · BMJ · doi:10.1136/bmj.c869 · Cited by 8,883 · see citing works
Proportional hazards tests and diagnostics based on weighted residuals
GRAMBSCH, P. M., & THERNEAU, T. M. (1994) · Biometrika · doi:10.1093/biomet/81.3.515 · Cited by 5,885 · see citing works
Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), societies, E. B. T. F., European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp298 · Cited by 2,040 · see citing works
Self-citationMoher, D., Hopewell, S., Schulz, K. F., Montori, V., Gøtzsche, P. C., Devereaux, P. J., Elbourne, D., Egger, M., & Altman, D. G. (2010) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.03.004 · Cited by 1,858 · see citing works
Almquist, A. K., Goldenberg, I. F., Milstein, S., Chen, M. Y., Chen, X., Hansen, R., Gornick, C. C., & Benditt, D. G. (1989) · New England Journal of Medicine · doi:10.1056/nejm198902093200603 · Cited by 643 · see citing works
Shrier, I., Boivin, J.-F., Steele, R. J., Platt, R. W., Furlan, A. D., Kakuma, R., Brophy, J. M., & Rossignol, M. (2007) · American Journal of Epidemiology · doi:10.1093/aje/kwm189 · Cited by 493 · see citing works
Brignole, M., Menozzi, C., Moya, A., Andresen, D., Blanc, J. J., Krahn, A. D., Wieling, W., Beiras, X., Deharo, J. C., Russo, V., et al. (2012) · Circulation · doi:10.1161/circulationaha.111.082313 · Cited by 437 · see citing works
Self-citationMoher, D., Hopewell, S., Schulz, K. F., Montori, V. M., Gøtzsche, P. C., Devereaux, P. J., Elbourne, D. R., Egger, M., & Altman, D. G. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2011.10.006 · Cited by 414 · see citing works
Pereira, C. A. D. B., & de Castilho, E. A. (2009) · American Journal of Epidemiology · doi:10.1093/aje/kwp016 · Cited by 374 · see citing works
Sheldon, R., Connolly, S., Rose, S., Klingenheben, T., Krahn, A., Morillo, C., Talajic, M., Ku, T., Fouad-Tarazi, F., Ritchie, D., et al. (2006) · Circulation · doi:10.1161/circulationaha.105.535161 · Cited by 278 · see citing works
Self-citationGolder, S., Loke, Y. K., & Bland, M. (2011) · PLoS Medicine · doi:10.1371/journal.pmed.1001026 · Cited by 270 · see citing works
Diagnostic criteria for vasovagal syncope based on a quantitative history
Sheldon, R., Rose, S., Connolly, S., Ritchie, D., Koshman, M.-L., & Frenneaux, M. (2006) · European Heart Journal · doi:10.1093/eurheartj/ehi584 · Cited by 252 · see citing works
Self-citationMidodrine: a role in the management of neurocardiogenic syncope
Ward, C. R., Gray, J. C., Gilroy, J. J., & Kenny, R. A. (1998) · Heart · doi:10.1136/hrt.79.1.45 · Cited by 249 · see citing works
Risk Factors for Syncope Recurrence After a Positive Tilt-Table Test in Patients With Syncope
Sheldon, R. S., Rose, S., Flanagan, P., Koshman, M. L., & Killam, S. (1996) · Circulation · doi:10.1161/01.cir.93.5.973 · Cited by 231 · see citing works
Self-citationAge-related changes in vascular responses: a review
Marı́n, J. (1995) · Mechanisms of Ageing and Development · doi:10.1016/0047-6374(94)01551-v · Cited by 221 · see citing works
Madrid, A. H., Ortega, J., Rebollo, J. G., Manzano, J. G., Segovia, J. G., Sánchez, A., Peña, G., & Moro, C. (2001) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(00)01155-4 · Cited by 205 · see citing works
Mahanonda, N., Bhuripanyo, K., Kangkagate, C., Wansanit, K., Kulchot, B.-O., Nademanee, K., & Chaithiraphan, S. (1995) · American Heart Journal · doi:10.1016/0002-8703(95)90150-7 · Cited by 177 · see citing works
Methodology of isoproterenol-tilt table testing in patients with syncope
Sheldon, R. S., & Killam, S. (1992) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(92)90517-q · Cited by 170 · see citing works
Self-citationMidodrine in neurally mediated syncope: A double‐blind, randomized, crossover study
Kaufmann, H., Saadia, D., & Voustianiouk, A. (2002) · Annals of Neurology · doi:10.1002/ana.10293 · Cited by 137 · see citing works
Flevari, P., LIVANIS, E. G., THEODORAKIS, G. N., Zarvalis, E., Mesiskli, T., & Kremastinos, D. T. H. (2002) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(02)01974-5 · Cited by 137 · see citing works
Age of First Faint in Patients with Vasovagal Syncope
SHELDON, R. S., SHELDON, A. G., CONNOLLY, S. J., MORILLO, C. A., KLINGENHEBEN, T., KRAHN, A. D., KOSHMAN, M., RITCHIE, D., & for the Investigators of the Syncope Symptom Study and the Prevention of Syncope Trial (2006) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2005.00267.x · Cited by 134 · see citing works
Self-citationSheldon, R. S., Rose, S., Flanagan, P., Koshman, M. L., & Killam, S. (1996) · The American Journal of Cardiology · doi:10.1016/s0002-9149(96)00359-1 · Cited by 121 · see citing works
Self-citationThe efficacy of midodrine hydrochloride in the treatment of children with vasovagal syncope
Qingyou, Z., Junbao, D., & Chaoshu, T. (2006) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2006.07.031 · Cited by 108 · see citing works
Acute and long-term beta-adrenergic blockade for patients with neurocardiogenic syncope
Vigh, A. G., & DeAntonio, H. (1996) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(96)90110-2 · Cited by 106 · see citing works
Acute and long-term beta-adrenergic blockade for patients with neurocardiogenic syncope
Cox, M. M., Perlman, B. A., Mayor, M., Silberstein, T., Levin, E., Pringle, L., Castellanos, A., & Myerburg, R. J. (1995) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(95)00320-7 · Cited by 105 · see citing works
Verheyden, B., Liu, J., van Dijk, N., Westerhof, B. E., Reybrouck, T., Aubert, A. E., & Wieling, W. (2008) · Heart Rhythm · doi:10.1016/j.hrthm.2008.09.003 · Cited by 101 · see citing works
Raj, S. R., Rose, S., Ritchie, D., & Sheldon, R. S. (2006) · American Heart Journal · doi:10.1016/j.ahj.2006.03.013 · Cited by 78 · see citing works
Self-citationOlsen, H., Vernersson, E., & Länne, T. (2000) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.2000.278.1.h222 · Cited by 78 · see citing works
Ventura, R., Maas, R., ZEIDLER, D., Schoder, V., NIENABER, C. A., Schuchert, A., & Meinertz, T. (2002) · Pacing and Clinical Electrophysiology · doi:10.1046/j.1460-9592.2002.t01-1-00816.x · Cited by 74 · see citing works
Mak, A., Cheung, M. W. ‐., Ho, R., Cheak, A. A.-C., & Lau, C. S. (2009) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-10-113 · Cited by 74 · see citing works
Comparison of Patients With Syncope of Unknown Cause Having Negative or Positive Tilt-Table Tests
Sheldon, R. S., Rose, S., & Koshman, M. L. (1997) · The American Journal of Cardiology · doi:10.1016/s0002-9149(97)00425-6 · Cited by 56 · see citing works
Self-citationTheodorakis, G. N., Markianos, M., Zarvalis, E., Livanis, E. G., Flevari, P., & Kremastinos, D. T. (2000) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(00)00719-1 · Cited by 56 · see citing works
Vascular β-adrenoceptor function in hypertension and in ageing
Werstiuk, E. S., & Lee, R. M. K. W. (2000) · Canadian Journal of Physiology and Pharmacology · doi:10.1139/cjpp-78-6-433 · Cited by 52 · see citing works
Leor, J., Rotstein, Z., Vered, Z., Kaplinsky, E., Truman, S., & Eldar, M. (1994) · American Heart Journal · doi:10.1016/0002-8703(94)90383-2 · Cited by 50 · see citing works
Evidence-based treatment for vasovagal syncope
Kuriachan, V., Sheldon, R. S., & Platonov, M. (2008) · Heart Rhythm · doi:10.1016/j.hrthm.2008.08.023 · Cited by 47 · see citing works
Self-citationVascular β-adrenoceptor function in hypertension and in ageing
Werstiuk, E. S., & Lee, R. M. (2000) · Canadian Journal of Physiology and Pharmacology · doi:10.1139/y00-015 · Cited by 46 · see citing works
Effects of aging on responses to isoproterenol tilt-table testing in patients with syncope
Sheldon, R. S. (1994) · The American Journal of Cardiology · doi:10.1016/0002-9149(94)90903-2 · Cited by 42 · see citing works
Self-citationRationale for the prevention of syncope trial IV: assessment of midodrine
Raj, S. R., Faris, P., McRae, M., & Sheldon, R. S. (2012) · Clinical Autonomic Research · doi:10.1007/s10286-012-0167-5 · Cited by 39 · see citing works
Self-citationEstimating treatment effect via simple cross design synthesis
Kaizar, E. E. (2011) · Statistics in Medicine · doi:10.1002/sim.4339 · Cited by 39 · see citing works
Alegría, J. R., Gersh, B. J., Scott, C. G., Hodge, D. O., Hammill, S. C., & Shen, W.-K. (2003) · The American Journal of Cardiology · doi:10.1016/s0002-9149(03)00475-2 · Cited by 34 · see citing works
Sheldon, R. S. (2002) · EP Europace · doi:10.1053/eupc.2002.0284 · Cited by 34 · see citing works
Self-citationNatale, A., Newby, K. H., Dhala, A. A., Akhtar, M., & Sra, J. S. (1996) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.1996.tb00494.x · Cited by 33 · see citing works
Delepine, S., Prunier, F., Lefthériotis, G., Dupuis, J.-M., Vielle, B., Geslin, P., & Victor, J. (2002) · The American Journal of Cardiology · doi:10.1016/s0002-9149(02)02519-5 · Cited by 31 · see citing works
Dendi, R., & Goldstein, D. S. (2002) · The American Journal of Cardiology · doi:10.1016/s0002-9149(02)02338-x · Cited by 28 · see citing works
Randomized trials and observational studies: still mostly similar results, still crucial differences
Kunz, R. (2008) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2007.05.021 · Cited by 24 · see citing works
Ermiş, C., Samniah, N., Sakaguchi, S., Lurie, K. G., Pham, S., Lü, F., & Benditt, D. G. (2004) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2003.09.047 · Cited by 22 · see citing works
Shigemi, K., Brunner, M. J., & Shoukas, A. A. (1994) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.1994.267.1.h201 · Cited by 21 · see citing works
Age-related hemodynamic changes during vasovagal syncope
Folino, A. F., Migliore, F., Marinelli, A., Iliceto, S., & Buja, G. (2010) · Autonomic Neuroscience · doi:10.1016/j.autneu.2010.04.009 · Cited by 19 · see citing works
Usefulness of clinical factors in predicting outcomes of passive tilt tests in patients with syncope
Sheldon, R. S., Sexton, E., & Koshman, M. L. (2000) · The American Journal of Cardiology · doi:10.1016/s0002-9149(99)00747-x · Cited by 19 · see citing works
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Sheldon, R. S., Grubb, B. P., Olshansky, B., Shen, W.-K., Calkins, H., Brignole, M., Raj, S. R., Krahn, A. D., Morillo, C. A., Stewart, J. M., et al. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.03.029 · Cited by 1,013 · see citing works
“However, in a meta analysis of a prespecified, prestratified substudy of POST 1 and a large earlier observational study, there was evidence of benefit in patients older than 40 years.(122) A prospective, multicenter, randomized clinical trial is now testing this effect (POST 5).”
MethodSelf-citation2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.03.004 · Cited by 484 · see citing works
“However, in a meta-analysis of a prespecified, prestratified substudy of POST I and a large observational study, an age-dependent benefit of beta blockers among patients $42 years of age was found, compared with those of younger age (394,395).”
ResultSelf-citationShen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000499 · Cited by 453 · see citing works
“(259) Study type: Post-hoc POST; retrospective observational”
Self-citationShen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000498 · Cited by 408 · see citing works
Self-citation2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.03.003 · Cited by 327 · see citing works
Self-citationFludrocortisone for the Prevention of Vasovagal Syncope
Sheldon, R., Raj, S. R., Rose, M. S., Morillo, C. A., Krahn, A. D., Medina, E., Talajic, M., Kus, T., Seifer, C. M., Lelonek, M., et al. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.04.030 · Cited by 155 · see citing works
Sun, W., Zheng, L., Yu, Q., Shi, R., Hou, B., Wu, L., Guo, J., Zhang, S., & Yao, Y. (2016) · Journal of the American Heart Association · doi:10.1161/jaha.116.003471 · Cited by 133 · see citing works
The management of vasovagal syncope
Kenny, R. A., & McNicholas, T. (2016) · QJM · doi:10.1093/qjmed/hcw089 · Cited by 100 · see citing works
Saklani, P., Krahn, A. D., & Klein, G. J. (2013) · Circulation · doi:10.1161/circulationaha.112.138396 · Cited by 89 · see citing works
“007).(86) β-Blocker use reduced syncope recurrence in those aged ≥42 years by 48% but increased the risk in those aged < 42years by 58%.”
Self-citationACC/AHA/HRS Versus ESC Guidelines for the Diagnosis and Management of Syncope
Goldberger, Z. D., Petek, B. J., Brignole, M., Shen, W.-K., Sheldon, R. S., Solbiati, M., Deharo, J.-C., Moya, A., & Hamdan, M. H. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.09.012 · Cited by 82 · see citing works
Self-citationMidodrine for the Prevention of Vasovagal Syncope
Sheldon, R. S., Faris, P., TANG, A. S. L., Paredes, F. A., Guzmán, J. C., Márquez, M. F., Morillo, C. A., Krahn, A. D., Kuś, T., Ritchie, D., et al. (2021) · Annals of Internal Medicine · doi:10.7326/m20-5415 · Cited by 70 · see citing works
“b -Blockers might be effective in older patients (20, 33).”
BackgroundSelf-citationAhn, J., Kim, H. J., Choi, J., Lee, K., Shim, J., Ahn, H. S., & Kim, Y. (2017) · PLoS ONE · doi:10.1371/journal.pone.0185680 · Cited by 70 · see citing works
Syncope: Diagnosis and Management
Walsh, K., Hoffmayer, K. S., & Hamdan, M. H. (2014) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2014.11.001 · Cited by 49 · see citing works
Liao, Y., & Du, J.-B. (2020) · Neuroscience Bulletin · doi:10.1007/s12264-020-00497-4 · Cited by 39 · see citing works
“It is notable that a number of studies have revealed that b-blockers are beneficial in certain age groups [16, 28, 30].”
BackgroundSheldon, R. S., Lei, L. Y., Guzmán, J. C., Kuś, T., Paredes, F. A., Angihan, J., Safdar, S., Maxey, C., Bennett, G., & Raj, S. R. (2019) · EP Europace · doi:10.1093/europace/euz250 · Cited by 36 · see citing works
Self-citationNeurohormones in the Pathophysiology of Vasovagal Syncope in Adults
Benditt, D. G., van Dijk, J. G., Krishnappa, D., Adkisson, W. O., & Sakaguchi, S. (2020) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2020.00076 · Cited by 36 · see citing works
“On the other hand, as has been suggested by others (55, 56), older patients appear to release less epinephrine than do younger individuals.”
Raj, S. R., Faris, P., Semeniuk, L., Manns, B., Krahn, A. D., Morillo, C. A., Benditt, D. G., & Sheldon, R. S. (2016) · American Heart Journal · doi:10.1016/j.ahj.2016.01.017 · Cited by 24 · see citing works
Self-citationNg, J., Sheldon, R. S., Maxey, C., Ritchie, D., Raj, V., Exner, D. V., & Raj, S. R. (2019) · Autonomic Neuroscience · doi:10.1016/j.autneu.2019.04.001 · Cited by 24 · see citing works
Self-citationCheshire, W. P. (2017) · CONTINUUM Lifelong Learning in Neurology · doi:10.1212/con.0000000000000444 · Cited by 24 · see citing works
“92) in neurally mediated syncope recurrence, whereas younger patients did not.(108) Another preventative approach has been the !1-adrenergic receptor agonist midodrine, with the goal of maintaining peripheral vascular tone and preventing vasodilatation.”
Norepinephrine transport inhibition for treatment of vasovagal syncope
SHELDON, R. S., RITCHIE, D., MCRAE, M., & RAJ, S. (2013) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12111 · Cited by 22 · see citing works
Self-citationManagement of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia and Vasovagal Syncope
Raj, S. R., & Sheldon, R. S. (2016) · Arrhythmia & Electrophysiology Review · doi:10.15420/aer.2016.7.2 · Cited by 21 · see citing works
Self-citationManual zur Diagnostik und Therapie von Synkopen
von Scheidt, W., Bosch, R., Klingenheben, T., Schuchert, A., Stellbrink, C., & Stockburger, M. (2019) · Der Kardiologe · doi:10.1007/s12181-019-0319-0 · Cited by 21 · see citing works
Self-citationNon-invasive management of vasovagal syncope
Coffin, S. T., & Raj, S. R. (2014) · Autonomic Neuroscience · doi:10.1016/j.autneu.2014.06.004 · Cited by 21 · see citing works
“31) for patients b42 years of age (Sheldon et al., 2012).”
BackgroundInfluentialCardioinhibitory syncope: from pathophysiology to treatment—should we think on cardioneuroablation?
García, A., Márquez, M. F., Fierro, E. F., Baez, J. J., Campos, L. P. R., & Gómez-Flores, J. R. (2020) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-020-00758-2 · Cited by 22 · see citing works
Cardioneuroablation changes the type of vasovagal response in patients with asystolic reflex syncope
Piotrowski, R., Żuk, A., Baran, J. M., Sikorska, A., Kryński, T., & Kułakowski, P. (2021) · Autonomic Neuroscience · doi:10.1016/j.autneu.2021.102838 · Cited by 19 · see citing works
Management strategies for vasovagal syncope
Ali, M., Maetos, J. C. P., Kichloo, A., Masudi, S. T., Grubb, B. P., & Kanjwal, K. (2021) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.14402 · Cited by 18 · see citing works
Treatment of Neurally Mediated Reflex Syncope
Guzmán, J. C., Armaganijan, L., & Morillo, C. A. (2012) · Cardiology Clinics · doi:10.1016/j.ccl.2012.10.007 · Cited by 17 · see citing works
“However, a recent report suggests that, in patients older than 42 years, metoprolol may be effective.(32) Based on a 48% relative risk reduction (RRR) in time to first recurrence of syncope in subjects older than 42 years reported from the POST trial, it is reasonable to try metoprolol in this specific population.”
BackgroundSelf-citationEvaluation of syncope: focus on diagnosis and treatment of neurally mediated syncope
Lee, A. K. Y., & Krahn, A. D. (2016) · Expert Review of Cardiovascular Therapy · doi:10.1586/14779072.2016.1164034 · Cited by 17 · see citing works
Self-citationMárquez, M. F., Gómez-Flores, J. R., González-Hermosillo, J. A., Ruíz-Siller, T. D. J., & Cárdenas, M. (2016) · Medwave · doi:10.5867/medwave.2016.6824 · Cited by 17 · see citing works
Recurrent syncope: differential diagnosis and management
Bennett, M. T., Leader, N., & Krahn, A. D. (2015) · Heart · doi:10.1136/heartjnl-2014-306627 · Cited by 16 · see citing works
Self-citationThe Role of the Autonomic Nervous System in Vasovagal Syncope
Arcinas, L. A., Morillo, C. A., Sheldon, R. S., & Raj, S. R. (2023) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2023.10.008 · Cited by 15 · see citing works
Self-citationDoes A Therapy for Reflex Vasovagal Syncope Really Exist?
Romano, S. L., Branz, L., Fondrieschi, L., & Minuz, P. (2019) · High Blood Pressure & Cardiovascular Prevention · doi:10.1007/s40292-019-00327-3 · Cited by 13 · see citing works
Postural Tachycardia Syndrome and Neurally Mediated Syncope
Cutsforth‐Gregory, J. K. (2020) · CONTINUUM Lifelong Learning in Neurology · doi:10.1212/con.0000000000000818 · Cited by 14 · see citing works
Current Pharmacological Management of Hypotensive Syndromes in the Elderly
Alagiakrishnan, K. (2015) · Drugs & Aging · doi:10.1007/s40266-015-0263-z · Cited by 11 · see citing works
“[130]) Vasovagal syncope Prevention Of Syncope Trial POST); observational cohort study Mean age\42 and[42 years 153 Reduction in syncope estimate in\42 years: HR 1.”
BackgroundNovedades en arritmias y estimulación cardiaca en 2013
Almendral, J. M., Pombo, M., Martínez-Alday, J. D., Rebollo, J. M. G., Font, E. R., Martínez-Ferrer, J., Castellanos, E., Fernandez, F., & Ruiz‐Mateas, F. (2014) · Revista Española de Cardiología · doi:10.1016/j.recesp.2013.12.014 · Cited by 11 · see citing works
Clinical Efficacy of Empirical Therapy in Children with Vasovagal Syncope
Tao, C., Cui, Y., Zhang, C., Liu, X., Zhang, Q., Liu, P., Wang, Y., Du, J., & Jin, H. (2022) · Children · doi:10.3390/children9071065 · Cited by 10 · see citing works
Vasovagal syncope: an update on the latest pharmacological therapies
Schleifer, J. W., & Shen, W.-K. (2014) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2015.996129 · Cited by 10 · see citing works
“Despite this recommendation, b blockers are possibly useful in older patients as identified in a subgroup analysis of the POST trial [53].”
BackgroundMatthews, I. G., Tresham, I. A. E., & Parry, S. W. (2015) · Cardiology Clinics · doi:10.1016/j.ccl.2015.04.009 · Cited by 16 · see citing works
“A multicenter randomized controlled study of metoprolol showed no benefit overall, but suggested benefit in patients older than 42 years.(57,58) This theory will be the subject of a further randomized trial of metoprolol in this age group (POST 5 [Prevention of Syncope Trial 5], RS Sheldon, personal communication,”
BackgroundLin, J., Liu, Q., Jiang, R., Chen, S., Yu, L., & Jiang, C. (2023) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.14769 · Cited by 9 · see citing works
Treatment of Neurocardiogenic Syncope: From Conservative to Cutting-edge
Gampa, A., & Upadhyay, G. A. (2018) · Journal of Innovations in Cardiac Rhythm Management · doi:10.19102/icrm.2018.090702 · Cited by 10 · see citing works
Update on Arrhythmias and Cardiac Pacing 2013
Almendral, J. M., Pombo, M., Martínez-Alday, J. D., Rebollo, J. M. G., Font, E. R., Martínez-Ferrer, J., Castellanos, E., Fernandez, F., & Ruiz‐Mateas, F. (2014) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2013.12.012 · Cited by 8 · see citing works
Vasovagal Syncope: A Review of Current and Future Strategies
Dani, M., Panagopoulos, D., Dirksen, A., Taraborrelli, P., Torocastro, M., Sutton, R., & Lim, P. B. (2021) · European Journal of Arrhythmia & Electrophysiology · doi:10.17925/ejae.2021.7.1.40 · Cited by 8 · see citing works
“However, when post-hoc analyses stratified participants by age, there was a significant benefit in individuals over 42 years old.(38) A randomized, controlled trial, the POST-5 study, is currently underway to assess efficacy in individuals over 40 years.”
MethodOngoing Clinical Trials for Vasovagal Syncope: Where are we in 2014?
Coffin, S. T., & Raj, S. R. (2014) · Autonomic Neuroscience · doi:10.1016/j.autneu.2014.05.009 · Cited by 7 · see citing works
Yuan, P., Li, X., Tao, C., Du, X., Zhang, C., Du, J., Huang, Y., & Liao, Y. (2022) · International Journal of General Medicine · doi:10.2147/ijgm.s352928 · Cited by 7 · see citing works
Non-Pharmacological and Pharmacological Management of Cardiac Dysautonomia Syndromes
Lakkireddy, D. (2019) · Journal of Atrial Fibrillation · doi:10.4022/jafib.2395 · Cited by 6 · see citing works
Klein, K. M. (2016) · Clinical Epileptology · doi:10.1007/s10309-016-0096-8 · Cited by 4 · see citing works
Hemodynamic changes of unexplained syncope patients in head-up tilt test
Li, X., Liu, L. L., Wan, Y. J., & Peng, R. (2015) · Genetics and Molecular Research · doi:10.4238/2015.january.30.4 · Cited by 5 · see citing works
“In some cases, overexcitation of the vagus and parasympathetic nerves may cause sudden heart rate deceleration and peripheral vascular dilation, resulting in hypotension and brain hypoxia (Sheldon et al., 2012; Skerk et al., 2012).”
BackgroundSyncope update 2013: diagnosis and treatment
Kułakowski, P. (2013) · Kardiologia Polska · doi:10.5603/kp.2013.0031 · Cited by 5 · see citing works
“[40] studied the effects of beta blockers on syncope recurrences in different age groups.”
BackgroundDoes any therapy really work for neurocardiogenic syncope?
Hawkins, N. M., & Krahn, A. D. (2014) · Cardiology Journal · doi:10.5603/cj.2014.0094 · Cited by 5 · see citing works
“Subsequent pooled analysis with non-randomized patients found a significant interaction of beta-blockers with age, suggesting benefit after age 42, and potential harm in younger patients [8].”
MethodSelf-citationLifestyle Modification as a Method of Treatment of Vasovagal Syncope
Kuchinskaya, Е. А., & Певзнер, А. В. (2020) · Kardiologiia · doi:10.18087/cardio.2020.1.n776 · Cited by 4 · see citing works
Moya‐Mitjans, À. (2015) · Cardiology Clinics · doi:10.1016/j.ccl.2015.04.015 · Cited by 4 · see citing works
Wang, J., Li, H., Huang, X., Hu, H., Lian, B., Zhang, D., Wu, J., & Cao, L. (2024) · BMC Neurology · doi:10.1186/s12883-024-03623-1 · Cited by 1 · see citing works
“Furthermore, the effectiveness of β-blockers in preventing VVS has been found to be age-dependent, with potential effectiveness in older patients [35].”
BackgroundInfluentialSepehrvand, N., Hatami, S., Raj, S. R., Semeniuk, L., Hamzeh, R., Paredes, F. A., Becker, G., Kuś, T., Flevari, P., Moya‐Mitjans, À., et al. (2026) · CJC Open · doi:10.1016/j.cjco.2026.03.019 · Cited by 1 · see citing works
“13 The 2018 European Society of Cardiology guideline recommended that beta-adrenergic blocking drugs not be considered in the treatment of VVS (class III, Level of Evidence A).”
Self-citationMatthews, I. G., Tresham, I. A. E., & Parry, S. W. (2013) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2013.08.016 · Cited by 1 · see citing works
Moya‐Mitjans, À. (2013) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2013.08.015 · Cited by 1 · see citing works
Vasovagal syncope in 2016: the current state of the faint
Chew, D. S., Raj, S. R., & Sheldon, R. S. (2016) · Interventional Cardiology · doi:10.4172/interventional-cardiology.1000535 · Cited by 1 · see citing works
Self-citationvon Scheidt, W., Klingenheben, T., & BOSCH, R. F. (2020) · Der Internist · doi:10.1007/s00108-020-00821-0 · Cited by 2 · see citing works
Self-citationWhat can I do when first-line measures are not enough for vasovagal syncope?
Hutt, E., & Mayuga, K. A. (2018) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.85a.17112 · Cited by 1 · see citing works
Ganglionated plexi ablation to treat exercise-induced vasovagal syncope: A case report
Hong, X., Jiang, R., Zhu, J., & He, J. (2020) · HeartRhythm Case Reports · doi:10.1016/j.hrcr.2020.08.009 · Cited by 1 · see citing works
Indications for Permanent and Temporary Cardiac Pacing
John, R. M. (2014) · doi:10.1002/9781118459553.ch1 · Cited by 1 · see citing works
Kohno, R., Detloff, B. L. S., Chen, L. Y., Norby, F. L., & Benditt, D. G. (2019) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.13921 · Cited by 1 · see citing works
“Additional indirect evidence favoring the “epinephrine rise” hypothesis is provided to some extent by the findings of the POST study in which beta‐adrenergic blockade appeared to provide some therapeutic benefit.(3-5) The latter was, however, largely observed in older fainters(3-5) in whom a premonitory epinephrine ri…”
ResultKlingenheben, T., Ptaszynski, P. A., Schimpf, R. C., & Schuchert, A. (2013) · Herzschrittmachertherapie + Elektrophysiologie · doi:10.1007/s00399-013-0256-8 · Cited by 1 · see citing works
Self-citationKline, R. J., Pham, K., Labrie-Brown, C., Mancuso, K. F., LeLorier, P., Riopelle, J. M., & Kaye, A. D. (2016) · PubMed Central
DITTRICH, S., Laser, K. T., Deisenhofer, I., BLANKENBURG, M., & Lewin, M. A. G. (2015) · Elsevier eBooks · doi:10.1016/b978-3-437-22061-6.50473-0
Selective ablation of atrial ganglionated plexus as a therapeutic option for vasovagal syncope
Kishihara, J. (2018) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.13548
Challenges with the Diagnosis and Management of Hypotensive Syndromes in the Elderly
Alagiakrishnan, K. (2019) · Springer eBooks · doi:10.1007/978-3-030-30332-7_9
Schleifer, J. W., Sorajja, D., & Shen, W.-K. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-44733-1.00103-6
Klein, K. M., & Rosenow, F. (2015) · NeuroTransmitter · doi:10.1007/s15016-015-0508-4
“Betablocker zeigten in einer randomisierten Studie keinen E ekt [43], wobei Patienten über 42 Jahre möglicherweise doch pro tieren [44].”
BackgroundEditors, T. (2013) · Circulation · doi:10.1161/circulationaha.113.005495
“Conclusions—β-blocker treatment may suppress vasovagal syncope in middle-aged patients aged >42 years.(37)”
Gomes, J. A. (2020) · Springer eBooks · doi:10.1007/978-3-030-45066-3_30
Salih, M. (2025) · Springer eBooks · doi:10.1007/978-3-032-03240-9_3
Synkope im Kindes- und Jugendalter (S2k)
Dittrich, S., Dorka, R., & Pillekamp, F. (2025) · Elsevier eBooks · doi:10.1016/b978-3-437-21447-9.50122-7
- Authors
- Sheldon, R. S., Morillo, C. A., Klingenheben, T., Krahn, A. D., Sheldon, A., & Rose, M. S.
- Affiliations
- Goethe University Frankfurt (DE)
- Venue
- Circulation: Arrhythmia and Electrophysiology
- Published
- 2012-10
- Volume
- 5
- Issue
- 5
- Pages
- 920-926
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W2160392175
- Cited by
- 72
- References
- 48
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 8 · 2019: 8 · 2018: 3 · 2017: 7 · 2016: 10 · 2015: 8 · 2014: 8 · 2013: 7 · 2012: 1
- FWCI
- 7.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation Arrhythmia and Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Calgary
- Hospital Research Foundation
- Killam Trusts
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Keywords
- beta-blockers, vasovagal syncope, metoprolol, elderly patients, middle-aged patients, syncope prevention, age-stratified analysis
- MeSH terms
- Adrenergic beta-Antagonists, Adult, Age Factors, Double-Blind Method, Female, Humans, Male, Metoprolol, Middle Aged, Survival Rate, Proportional Hazards Models, Treatment Outcome, Tilt-Table Test, Syncope, Vasovagal
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