Recurrent vasovagal syncope: comparison between clomipramine and nitroglycerin as drug challenges during head-up tilt testing

doi:10.1093/eurheartj/ehp255

European Heart Journal Advance Access originally published online on June 25, 2009
European Heart Journal 2009 30(18):2249-2253; doi:10.1093/eurheartj/ehp255

This Article

	Full Text
	Full Text (PDF)
	All Versions of this Article: 30/18/2249 most recent ehp255v1
	E-letters: Submit a response
	Alert me when this article is cited
	Alert me when E-letters are posted
	Alert me if a correction is posted

Services

	Email this article to a friend
	Related articles in EHJ
	Similar articles in this journal
	Similar articles in PubMed
	Alert me to new issues of the journal
	Add to My Personal Archive
	Download to citation manager
	Request Permissions
	Disclaimer

Google Scholar

	Articles by Flevari, P.
	Articles by Kremastinos, D.

PubMed

	PubMed Citation
	Articles by Flevari, P.
	Articles by Kremastinos, D.

Social Bookmarking

	What's this?

Recurrent vasovagal syncope: comparison between clomipramine and nitroglycerin as drug challenges during head-up tilt testing

Panayota Flevari¹^,2^,*, Dionyssios Leftheriotis¹^,2, Christophoros Komborozos¹^,2, Katerina Fountoulaki¹^,2, Nikolaos Dagres¹^,2, George Theodorakis¹^,2 and Dimitrios Kremastinos¹^,2

¹ 2nd Department of Cardiology, Attikon University Hospital, Athens, Greece
² 2nd Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece

Received 1 November 2008; revised 8 April 2009; accepted 4 May 2009; online publish-ahead-of-print 25 June 2009.

^* Corresponding author. Tel: +30 694 494 2630, Fax: +30 210 583 2351, Email: pflevari{at}yahoo.com

See page 2174 for the editorial comment on this article (doi:10.1093/eurheartj/ehp290)

Aims: To compare the responses between clomipramine, a centrally actingsubstance, and nitroglycerin, with mainly peripheral action,when each drug is used during tilt test for the induction ofvasovagal syncope (VVS).

Methods and results: Hundred patients with recurrent episodes of classical VVS underwenttwo tilt tests in a randomized sequence. One test included 20min of tilt at 60° with intravenous administration of 5mg clomipramine (clomipramine tilt), whereas the other testincluded an initial 30 min period of passive 60° tilt, followedby sublingual spray administration of 400 µg nitroglycerin(nitroglycerin tilt). Fifty asymptomatic subjects served ascontrols. Following clomipramine tilt, a positive response occurredin 73 patients (73%), a negative response in 23 (23%), and drugintolerance in 4 (4%). With nitroglycerin tilt, these percentageswere 52, 48, and 0%, respectively. Significant differences wereobserved regarding positive responses (clomipramine vs. nitroglycerin:73/100 vs. 52/100, P < 0.05), as well as negative responses(23/100 vs. 48/100, respectively, P < 0.05). A high concordancerate was observed in positive responses.

Conclusion: In the evaluation of patients with recurrent classical VVS,clomipramine tilt is associated with an increased positive yieldrelative to nitroglycerin tilt. This suggests that central mechanismsmay be more important than peripheral ones in VVS pathogenesis.

Key Words: Tilt testing • Vasovagal syncope • Clomipramine • Nitroglycerin

Add to CiteULike CiteULike Add to Connotea Connotea Add to Del.icio.us Del.icio.us What's this?

Related articles in EHJ:

Tilt testing and neurally mediated syncope: too many protocols for one condition or specific protocols for different situations?: Angel Moya
EHJ 2009 10.1093/eurheartj/ehp290. [Extract] [Full Text]

This article has been cited by other articles:

A. Moya
Tilt testing and neurally mediated syncope: too many protocols for one condition or specific protocols for different situations?
Eur. Heart J., September 2, 2009; 30(18): 2174 - 2176.
[Full Text] [PDF]