Lucy Y Lei1, Satish R Raj1, Robert S Sheldon1. 1. 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.
Abstract
AIMS: Vasovagal syncope (VVS) is a common clinical condition that lacks effective medical therapies despite being associated with significant morbidity. Current guidelines suggest that midodrine, a prodrug for an α1-adrenergic receptor agonist, might suppress VVS but supporting studies have utilized heterogeneous methods and yielded inconsistent results. To evaluate the efficacy of midodrine to prevent syncope in patients with recurrent VVS by conducting a systematic review and meta-analysis of published studies. METHODS AND RESULTS: Relevant randomized controlled trials were identified from the MEDLINE, Embase, CENTRAL, and CINAHL databases without language restriction from inception to June 2021. All studies were conducted in clinical syncope populations and compared the benefit of midodrine vs. placebo or non-pharmacological standard care. Weighted relative risks (RRs) were estimated using random effects meta-analysis techniques. Seven studies (n = 315) met inclusion criteria. Patients were 33 ± 17 years of age and 31% male. Midodrine was found to substantially reduce the likelihood of positive head-up-tilt (HUT) test outcomes [RR = 0.37 (0.23-0.59), P < 0.001]. In contrast, the pooled results of single- and double-blind clinical trials (I2 = 54%) suggested a more modest benefit from midodrine for the prevention of clinical syncope [RR = 0.51 (0.33-0.79), P = 0.003]. The two rigorous double-blind, randomized, placebo-controlled clinical trials included 179 VVS patients with minimal between-study heterogeneity (I2 = 0%) and reported a risk reduction with midodrine [RR = 0.71 (0.53-0.95), P = 0.02]. CONCLUSIONS: Midodrine is effective in preventing syncope induced by HUT testing and less, but still significant, RR reduction in randomized, double-blinded clinical trials. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Vasovagal syncope (VVS) is a common clinical condition that lacks effective medical therapies despite being associated with significant morbidity. Current guidelines suggest that midodrine, a prodrug for an α1-adrenergic receptor agonist, might suppress VVS but supporting studies have utilized heterogeneous methods and yielded inconsistent results. To evaluate the efficacy of midodrine to prevent syncope in patients with recurrent VVS by conducting a systematic review and meta-analysis of published studies. METHODS AND RESULTS: Relevant randomized controlled trials were identified from the MEDLINE, Embase, CENTRAL, and CINAHL databases without language restriction from inception to June 2021. All studies were conducted in clinical syncope populations and compared the benefit of midodrine vs. placebo or non-pharmacological standard care. Weighted relative risks (RRs) were estimated using random effects meta-analysis techniques. Seven studies (n = 315) met inclusion criteria. Patients were 33 ± 17 years of age and 31% male. Midodrine was found to substantially reduce the likelihood of positive head-up-tilt (HUT) test outcomes [RR = 0.37 (0.23-0.59), P < 0.001]. In contrast, the pooled results of single- and double-blind clinical trials (I2 = 54%) suggested a more modest benefit from midodrine for the prevention of clinical syncope [RR = 0.51 (0.33-0.79), P = 0.003]. The two rigorous double-blind, randomized, placebo-controlled clinical trials included 179 VVS patients with minimal between-study heterogeneity (I2 = 0%) and reported a risk reduction with midodrine [RR = 0.71 (0.53-0.95), P = 0.02]. CONCLUSIONS: Midodrine is effective in preventing syncope induced by HUT testing and less, but still significant, RR reduction in randomized, double-blinded clinical trials. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Robert S Sheldon; Blair P Grubb; Brian Olshansky; Win-Kuang Shen; Hugh Calkins; Michele Brignole; Satish R Raj; Andrew D Krahn; Carlos A Morillo; Julian M Stewart; Richard Sutton; Paola Sandroni; Karen J Friday; Denise Tessariol Hachul; Mitchell I Cohen; Dennis H Lau; Kenneth A Mayuga; Jeffrey P Moak; Roopinder K Sandhu; Khalil Kanjwal Journal: Heart Rhythm Date: 2015-05-14 Impact factor: 6.343
Authors: Michele Brignole; Angel Moya; Frederik J de Lange; Jean-Claude Deharo; Perry M Elliott; Alessandra Fanciulli; Artur Fedorowski; Raffaello Furlan; Rose Anne Kenny; Alfonso Martín; Vincent Probst; Matthew J Reed; Ciara P Rice; Richard Sutton; Andrea Ungar; J Gert van Dijk Journal: Eur Heart J Date: 2018-06-01 Impact factor: 29.983
Authors: A Perez-Lugones; R Schweikert; S Pavia; J Sra; M Akhtar; F Jaeger; G F Tomassoni; W Saliba; F M Leonelli; D Bash; S Beheiry; J Shewchik; P J Tchou; A Natale Journal: J Cardiovasc Electrophysiol Date: 2001-08
Authors: Robert Sheldon; Satish R Raj; M Sarah Rose; Carlos A Morillo; Andrew D Krahn; Eduardo Medina; Mario Talajic; Teresa Kus; Colette M Seifer; Malgorzata Lelonek; Thomas Klingenheben; Ratika Parkash; Debbie Ritchie; Maureen McRae Journal: J Am Coll Cardiol Date: 2016-07-05 Impact factor: 24.094
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