Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, GAA02 HRIC Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
2nd Department of Cardiology, Attikon University Hospital, Athens, Greece.
Clin Auton Res. 2023 Dec;33(6):811-819. doi: 10.1007/s10286-023-01000-5. Epub 2023 Nov 16.
Vasovagal syncope is a common clinical condition that lacks effective medical therapies despite being associated with significant morbidity. Current guidelines suggest that serotonin-specific reuptake inhibitors might suppress vasovagal syncope but supporting studies have been small and heterogenous. The purpose of this study was to evaluate the efficacy of serotonin-specific reuptake inhibitors to prevent syncope in patients with recurrent vasovagal syncope by conducting a systematic review and meta-analysis of published studies.
Relevant randomized controlled trials were identified from the MEDLINE and Embase databases without language restriction from inception to August 2022, and ClinicalTrials.gov. All studies were conducted in clinical syncope populations and compared the benefit of serotonin versus placebo. Weighted relative risks were estimated using random effects meta-analysis techniques.
Three studies (n = 204) met inclusion criteria. Patients were 42 ± 13 years of age and 51% female. Serotonin-specific reuptake inhibitors were found to substantially reduce the likelihood of a patient having at least one recurrence of vasovagal syncope [relative risk (RR) 0.34 (0.20-0.60), p < 0.01] with minimal between-study heterogeneity (I = 0%, p = 0.67). Serotonin-specific reuptake inhibitors in two reports provided significant protection against clinical presyncope [RR 0.43 (0.24-0.77), p < 0.01], with minimal between-study heterogeneity (I = 0%, p = 0.80).
Serotonin-specific reuptake inhibitors may be effective in preventing syncope induced by head-up tilt testing and in syncope in the community in randomized, double-blinded clinical trials.
血管迷走性晕厥是一种常见的临床病症，尽管与显著的发病率相关，但缺乏有效的医学治疗方法。目前的指南建议，5-羟色胺特异性再摄取抑制剂可能抑制血管迷走性晕厥，但支持这些研究的证据规模较小且存在异质性。本研究旨在通过对已发表的研究进行系统评价和荟萃分析，评估 5-羟色胺特异性再摄取抑制剂在预防复发性血管迷走性晕厥患者晕厥中的疗效。
从 MEDLINE 和 Embase 数据库中，无语言限制地检索了从成立到 2022 年 8 月的相关随机对照试验，并检索了 ClinicalTrials.gov。所有研究均在临床晕厥人群中进行，比较了 5-羟色胺与安慰剂的益处。使用随机效应荟萃分析技术估计加权相对风险。
三项研究（n=204）符合纳入标准。患者年龄为 42±13 岁，51%为女性。5-羟色胺特异性再摄取抑制剂可显著降低患者至少一次血管迷走性晕厥复发的可能性[相对风险（RR）0.34（0.20-0.60），p<0.01]，且研究间异质性极小（I=0%，p=0.67）。两项研究报告中的 5-羟色胺特异性再摄取抑制剂对临床先兆晕厥提供了显著保护[RR 0.43（0.24-0.77），p<0.01]，且研究间异质性极小（I=0%，p=0.80）。
在随机、双盲临床试验中，5-羟色胺特异性再摄取抑制剂可能对直立倾斜试验引起的晕厥和社区晕厥有效。
