Recurrent vasovagal syncope: Comparison between clomipramine and nitroglycerin as drug challenges during head-up tilt testing

European Heart Journal

Volumn 30, Issue 18, 2009, Pages 2249-2253

  Flevari, Panayota ^a,b   Leftheriotis, Dionyssios ^a,b   Komborozos, Christophoros ^a,b   Fountoulaki, Katerina ^a,b   Dagres, Nikolaos ^a,b   Theodorakis, George ^a,b   Kremastinos, Dimitrios ^a,b  

^a NATIONAL AND KAPODISTRIAN UNIVERSITY OF ATHENS   (Greece)

^b ONASSIS CARDIAC SURGERY CENTER   (Greece)

Author keywords

Clomipramine; Nitroglycerin; Tilt testing; Vasovagal syncope

Indexed keywords

CLOMIPRAMINE; GLYCERYL TRINITRATE;

ADULT; ARTICLE; BLOOD PRESSURE MONITORING; CONTROLLED STUDY; DRUG MECHANISM; DRUG RESPONSE; FEMALE; GASTROINTESTINAL SYMPTOM; HUMAN; MAJOR CLINICAL STUDY; MALE; PRIORITY JOURNAL; RECURRENT DISEASE; SENSITIVITY AND SPECIFICITY; SYNCOPE; TILT TABLE TEST;

ADMINISTRATION, INHALATION; ADOLESCENT; ADULT; CENTRAL NERVOUS SYSTEM AGENTS; CLOMIPRAMINE; FEMALE; HUMANS; INJECTIONS, INTRAVENOUS; MALE; MIDDLE AGED; NITROGLYCERIN; PERIPHERAL NERVOUS SYSTEM AGENTS; RANDOM ALLOCATION; RECURRENCE; SYNCOPE, VASOVAGAL; TILT-TABLE TEST; YOUNG ADULT;

EID: 70349439194     PISSN: 0195668X     EISSN: 15229645     Source Type: Journal    
DOI: 10.1093/eurheartj/ehp255     Document Type: Article

References (20)

1. Brignole M, Alboni P, Benditt DG, Bergfeldt L, Blanc JJ, Thomsen PE, Gert van Dijk J, Fitzpatrick A, Hohnloser S, Janousek J, Kapoor W, Kenny RA, Kulakowski P, Masotti G, Moya A, Raviele A, Sutton R, Theodorakis G, Ungar A, Wieling W, Priori SG, Garcia MA, Budaj A, Cowie M, Deckers J, Burgos EF, Lekakis J, Lindhal A, Mazzotta G, Morais J, Oto A, Smiseth O, Menozzi C, Ector H, Vardas P, Task Force on Syncope, European Society of Cardiology. Guidelines on Management (Diagnosis and Treatment) of Syncope. Executive Summary-Update 2004. Eur Heart J 2004;25:2054-2072.
2. Medow MS, Stewart JM, Sanyal S, Mumtaz A, Sica D, Frishman WH. Pathophysiology, diagnosis and treatment of orthostatic hypotension and vasovagal syncope. Cardiol Rev 2008;16:4-20.
3. Sheldon R. Tilt testing for syncope: a reappraisal. Curr Opin Cardiol 2004;20:38-41.
4. Theodorakis G, Livanis EG, Leftheriotis D, Flevari P, Markianos M, Kremastinos DT. Head-up tilt test with clomipramine challenge in vasovagal syndrome-a new tilt testing protocol. Eur Heart J 2003;24:658-663.
5. Bartoletti A, Alboni P, Ammirati F, Brignole M, Del Rosso A, Foglia Manzillo G, Menozzi C, Raviele A, Sutton R. 'The Italian protocol': a simplified head-up tilt testing potentiated with oral nitroglycerin to assess patients with unexplained syncope. Europace 2000;2:339-342.
6. Theodorakis GN, Markianos M, Livanis EG, Zarvalis E, Flevari P, Kremastinos DT. Central serotonergic responsiveness in neurocardiogenic syncope: a clomipramine test challenge. Circulation 98:2724-2730.
7. Aerts AJJ, Dendale P. Nitrate stimulated tilt table testing: a review of the literature. Pacing Clin Electrophysiol 2003;26:1528-1537.
8. 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 for the American College of Physicians. Ann Intern Med 1997;126:989-996.
9. Sutton R, Brignole M. Overview of recommended diagnostic strategies. In: Benditt DG, Blanc JJ, Brignole M, Sutton R eds. The Evaluation and Treatment of Syncope A Handbook for Clinical Practice. 2nd ed. Massachusetts/Oxford/Victoria: Blackwell Publishing; 2006. p47-53.
10. Brignole M, Menozzi C, Del Rosso A, Costa S, Gaggioli G, Bottoni N, Bartoli P, Sutton R. New classification of hemodynamics of vasovagal syncope: beyond the VASIS classification. Analysis of the pre-syncopal phase of the tilt test without and with nitrgolycerine challenge. Europace 2000;2:66-76.
11. Gisolf J, Westerhof BE, van Dijk N, Wesserling KH, Wieling W, Karemaker JM. Sublingual nitroglycerin used in routine tilt testing provokes a cardiac outputmediated vasovagal response. J Am Coll Cardiol 2004;44:588-593.
12. Mitro P, Higowa E. Myocardial contractility and cardiac filling measured by impedance cardiography in patients with nitroglycerin-induced vasovagal syncope. Pacing Clin Electrophysiol 2006;29:1-8.
13. Tassorelli C, Joseph SA, Buzzi MG, Nappi G. The effects on the central nervous system of nitroglycerin-putative mechanisms and mediators. Prog Neurobiol 1999; 57:607-624.
14. Raviele A, Gasparini G, Di Pede F, Menozzi C, Brignole M, Dinelli M, Alboni P, Piccolo E. Nitroglycerin infusion during upright tilt: a new test for the diagnosis of vasovagal syncope. Am Heart J 1994;127:103-111.
15. Dabire H. Central 5-hydroxytryptamine (5-HT) receptors in blood pressure regulation. Therapie 1991;46:421-429.
16. Furlan R, Piazza S, Dell Orto S, Barbic F, Bianchi A, Mainardi L, Cerutti S, Pagani M, Malliani A. Cardiac autonomic patterns preceding occasional vasovagal reactions in healthy humans. Circulation 1998;98:1756-1761.
17. Mosqueda-Garcia R, Furlan R, Fernandez-Violante R, Desai T, Snell M, Jarai Z, Ananthram V, Robertson RM, Robertson D. Sympathetic and baroreceptor reflex function in neurally mediated syncope evoked by tilt. J Clin Invest 1997; 99:2736-2744.
18. Flevari P, Livanis E, Theodorakis G, Mesiskli T, Zarvalis E, Kremastinos D. Baroreflexes in vasovagal syncope: two types of abnormal response. Pacing Clin Electrophysiol 2002;25:1315-1323.
19. Brignole M, Sutton R, Menozzi C, Garcia-Civera R, Moya A, Wieling W, Andresen D, Benditt DG, Grovale N, De Santo T, Vardas P, for the 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. Eur Heart J 2006;27: 2232-2239.
20. Deharo JC, Jego C, Lanteaume A, Djiane P. An implantable loop recorder study of highly symptomatic vasovagal patients. The heart rhythm observed during a spontaneous syncope is identical to the recurrent syncope but not correlated with the head-up tilt test or adenosine triphosphate test. J Am Coll Cardiol 2006;47: 587-593.