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Serotonin reuptake inhibition for the prevention of vasovagal syncope: a systematic review and meta-analysis

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Abstract

Purpose

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.

Methods

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.

Results

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 (I2 = 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 (I2 = 0%, p = 0.80).

Conclusions

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.

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Data availability

Data will be provided following a reasoned request to the senior author.

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Authors and Affiliations

  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

    Priya Raj, Lucy Lei, Satish Raj & Robert Sheldon

  2. 2nd Department of Cardiology, Attikon University Hospital, Athens, Greece

    Panagiota Flevaris

Authors
  1. Priya Raj
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  2. Lucy Lei
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  3. Panagiota Flevaris
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  4. Satish Raj
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  5. Robert Sheldon
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Contributions

All authors contributed to the study conception and design. Data collection was performed by all authors. Data analysis and the first draft of the manuscript was written by RS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Robert Sheldon.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Raj, P., Lei, L., Flevaris, P. et al. Serotonin reuptake inhibition for the prevention of vasovagal syncope: a systematic review and meta-analysis. Clin Auton Res 33, 811–819 (2023). https://doi.org/10.1007/s10286-023-01000-5

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  • DOI: https://doi.org/10.1007/s10286-023-01000-5

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