Norepinephrine Transport Inhibition for Treatment of Vasovagal Syncope
Article first published online: 27 FEB 2013
© 2013 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 24, Issue 7, pages 799–803, July 2013
How to Cite
SHELDON, R. S., RITCHIE, D., MCRAE, M. and RAJ, S. (2013), Norepinephrine Transport Inhibition for Treatment of Vasovagal Syncope. Journal of Cardiovascular Electrophysiology, 24: 799–803. doi: 10.1111/jce.12111
- Issue published online: 1 JUL 2013
- Article first published online: 27 FEB 2013
- Accepted manuscript online: 11 FEB 2013 04:48AM EST
- Manuscript Accepted: 29 JAN 2013
- Manuscript Revised: 24 JAN 2013
- Manuscript Received: 17 JAN 2013
- norepinephrine transporter;
Norepinephrine Transporter and Syncope
Norepinephrine transporter inhibitors, such as sibutramine, have been shown to prevent vasovagal syncope induced by tilt testing in healthy volunteers. As a test of concept we assessed whether sibutramine prevents fainting in highly symptomatic VVS patients.
Methods and Results
This was an open label, dose-ranging protocol of sibutramine 10, 15, and 20 mg daily for ≥4 weeks per dose, with progression dictated by response and tolerance. Responders were predefined as having >50% reduction in spell frequency, compared to baseline spell frequency. The cohort included seven subjects (6 women; 32 ± 7 years) who had a median of 593 faints over a median of 180 months. The patients had had 7 ± 4 previous treatment attempts without a satisfactory response. The mean duration of exposure to 10 mg, 15 mg, and 20 mg doses were 45 ± 33 days, 98 ± 89 days, and 137 ± 83 days. Six patients tolerated the maximum dose, and 1 patient dropped out due to adverse effects at 15 mg/day. The median frequency of spells at baseline, 10, 15, and 20 mg/day was 12, 4.4, 2.8, and 1 events/28 days (P = 0.0048). Five patients were responders and 2 were nonresponders. Among responders, the median frequency of spells at baseline, 10, 15, and 20 mg/day was 14, 4.8, 0.8, and 0.4 events per 28 days (P = 0.0089). No patients developed hypertension.
In this open label series, sibutramine prevented vasovagal syncope in most highly symptomatic patients.