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1.
Europace ; 16(2): 284-8, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24072450

RESUMO

AIMS: Ivabradine, an I(f) current blocker, has shown promising results in treatment of postural orthostatic tachycardia syndrome (POTS). There is a subgroup of vasovagal syncope (VVS) patients, who demonstrate sinus tachycardia before collapse on tilt testing mimicking some features of POTS. These patients may also respond to ivabradine therapy. University Hospital Syncope Clinic where ivabradine was prescribed in a prospective fashion on humanitarian grounds between October 2008 and December 2011. METHODS AND RESULTS: Twenty-five patients of mean age 33±years presenting syncope in all and palpitation in 23, duration 9±years underwent tilt testing with reproduction of usual symptoms including tachycardia preceding collapse. Ivabradine was prescribed in doses of 5-20 mg/day, mean 10.7 mg, as once or twice daily medication. The response to treatment was classified as deterioration in none, no change in 5, improvement in 10, and symptoms abolished in 8 patients. Side effects were minimal; one patient required discontinuation. CONCLUSION: In this pilot study of ivabradine, in patients with VVS, of patients who demonstrated sinus tachycardia before collapse on tilt, 72% reported a marked benefit or complete resolution of symptoms. The drug was well tolerated. A randomized controlled trial against placebo is justified.


Assuntos
Antiarrítmicos/uso terapêutico , Benzazepinas/uso terapêutico , Síncope Vasovagal/tratamento farmacológico , Taquicardia Sinusal/tratamento farmacológico , Adolescente , Adulto , Idoso , Antiarrítmicos/administração & dosagem , Antiarrítmicos/efeitos adversos , Benzazepinas/administração & dosagem , Benzazepinas/efeitos adversos , Esquema de Medicação , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Ivabradina , Londres , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/etiologia , Síncope Vasovagal/fisiopatologia , Taquicardia Sinusal/complicações , Taquicardia Sinusal/diagnóstico , Taquicardia Sinusal/fisiopatologia , Teste da Mesa Inclinada , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
2.
Europace ; 11(12): 1696-701, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19880853

RESUMO

AIMS: During head-up tilt (HUT) testing, a period of haemodynamic instability, marked by oscillations in blood pressure, often precedes vasovagal syncope. We hypothesized that the presence of oscillations in blood pressure during HUT testing predicts a positive diagnosis for vasovagal syncope. METHODS AND RESULTS: The haemodynamic profiles of 42 consecutive patients non-responsive to passive HUT and glyceryl trinitrate (GTN) provocation ('non-responders') and, contemporaneously, 41 consecutive patients responsive to passive HUT and GTN provocation ('responders') were assigned oscillation-positive or oscillation-negative depending on the presence or absence of a characteristic oscillation in systolic blood pressure which varied by > or =30 mmHg (peak-to-trough). All the non-responders proceeded to an isoprenaline (Iso) challenge test. Of the 42 non-responders, 27 patients were Iso tilt-positive; all of these patients were assigned oscillation-positive. The other 15 non-responders were Iso tilt-negative; of these 9 were assigned oscillation-positive and 6 were assigned oscillation-negative. Of the 41 responder patients, 33 were assigned oscillation-positive, whereas 8 were assigned oscillation-negative. Overall, the presence of oscillations as a diagnostic predictor for vasovagal syncope had a sensitivity of 88% (positive predictive value of 87%) and a specificity of 40% (negative predictive value of 43%). CONCLUSION: In patients non-responsive to passive HUT and GTN provocation, the presence of an oscillating systolic blood pressure varying > or =30 mmHg may still indicate a diagnosis of vasovagal syncope, possibly obviating the need for Iso testing.


Assuntos
Determinação da Pressão Arterial/métodos , Diagnóstico por Computador/métodos , Oscilometria/métodos , Síncope Vasovagal/diagnóstico , Teste da Mesa Inclinada/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
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