Fluoxetine vs. propranolol in the treatment of vasovagal syncope: a prospective, randomized, placebo-controlled study.

Abstract

AIMS:

To compare the therapeutic efficacy of placebo, propranolol, and fluoxetine in patients with vasovagal syncope (VVS).

METHODS AND RESULTS:

Ninety-six consecutive patients with VVS were randomized to treatment with placebo, propranolol, or fluoxetine and followed-up for 6 months. Before and during treatment, they reported their syncopal and presyncopal episodes and graded their well-being, expressed as the general evaluation of life, general activities, and everyday activities (each scaled from 1 = very good to 5 = very bad). Two patients refused follow-up. Among the remaining 94, no difference between groups was observed regarding the distribution of time of vasovagal events (syncopes or presyncopes) during follow-up (log-rank test). No difference was also observed when syncopes and presyncopes were assessed separately. Eighteen patients discontinued therapy. Among the remaining 76 ('on-treatment' analysis), the mean time to a vasovagal episode (syncope or presyncope) was significantly longer in the fluoxetine group when compared with the two other groups (log-rank test, P < 0.05). A significant difference in favour of fluoxetine was also observed regarding presyncopes. The difference between groups regarding the syncope-free period was not significant. During therapy, patients' well-being was improved (decreased) only in the fluoxetine-group (13.4 +/- 0.7 vs. 15.4 +/- 0.9 before treatment, P < 0.01).

CONCLUSION:

Fluoxetine seems to be equivalent to propranolol and placebo in the treatment of VVS. However, it improves patients' well-being and might be more effective in reducing presyncopes and total vasovagal events in some patients with recurrent VVS.

• Authors: George N Theodorakis, Dionyssios Leftheriotis, Efthimios G Livanis, Panagiota Flevari, Georgia Karabela, Nikolitsa Aggelopoulou, Dimitrios Th Kremastinos
• Journal: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology (Europace) Vol. 8 Issue 3 Pg. 193-8 (Mar 2006) ISSN: 1099-5129 [Print] England
• PMID: 16627439 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Adrenergic beta-Antagonists
• Serotonin Uptake Inhibitors
• Fluoxetine
• Propranolol

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Adult
• Attitude to Health
• Double-Blind Method
• Female
• Fluoxetine (therapeutic use)
• Humans
• Male
• Propranolol (therapeutic use)
• Quality of Life
• Recurrence
• Selective Serotonin Reuptake Inhibitors (therapeutic use)
• Syncope, Vasovagal (drug therapy)