Advertisement

Patient-Activated Implantable Drug Pump for Treatment of Vasovagal Syncope: Is It Time for Clinical Use?

  • A. Raviele
  • F. Giada
Conference paper

Abstract

An implantable drug delivery system theoretically has a use in many arrhythmic situations, such as paroxysmal atrial fibrillation/atrial flutter, other supraventricular tachyarrhythmias, ventricular tachycardia, and vasovagal syncope. In this chapter the potential role of an implantable drug delivery system for treatment of vasovagal syncope is discussed.

Keywords

Drug Delivery System Vasovagal Syncope Placebo Injection Supraventricular Tachyarrhythmia Syncope Recurrence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Raviele A, Brignole M, Menozzi C et al (1997) Development of an implantable drug delivery system for the treatment of vasovagal syncope: a dream or a real prospect? In Raviele A (ed) Cardiac arrhythmias. Springer, Milan, pp 422–427Google Scholar
  2. 2.
    Sheldon R, Rose S, Flanagan P et al (1996) Risk factors for syncope recurrence after a positive tilt table test in patients with syncope. Circulation 93:973–981PubMedCrossRefGoogle Scholar
  3. 3.
    Raviele A, Themistoclakis S, Gasparini G (1996) Drug treatment of vasovagal syncope. In: Blanc JJ, Benditt D, Sutton R (eds) Neurally mediated syncope: pathophysio-logy, investigations and treatment. Futura, Armonk, NY, pp 113–117Google Scholar
  4. 4.
    Kelly PA, Mann DE, Adler SW et al (1994) Low dose disopyramide often fails to prevent neurogenic syncope during head-up tilt testing. Pacing Clin Electrophysiol 11:1202–1206Google Scholar
  5. 5.
    Brignole M, Menozzi C, Gianfranchi L et al (1992) A controlled trial of acute and long-term medical therapy in tilt-induced neurally mediated syncope. Am J Cardiol 70:339–342PubMedCrossRefGoogle Scholar
  6. 6.
    Morillo CA, Leicht JW, Yee R et al (1993) A placebo-controlled trial of intravenous and oral disopyramide for prevention of neurally mediated syncope induced by head-up tilt. J Am Coll Cardiol 22:1843–1848PubMedCrossRefGoogle Scholar
  7. 7.
    Raviele A, Brignole M, Sutton R et al (1999) Effect of etilefrine in preventing syncopal recurrence in patients with vasovagal syncope. A double-blind, randomized, placebo-controlled trial. Circulation 99:1452–1457Google Scholar
  8. 8.
    Madrid AH, Ortega J, Rebollo J et al (2001 ) Lack of efficacy of atenolol for the prevention of neurally mediated syncope in a highly symptomatic population: a prospective, double-blind, randomized and placebo-controlled study. J Am Coll Cardiol 37:554–559Google Scholar
  9. 9.
    Flevari P, Livanis EG, Theodorakis G et al (2002) Vasovagal syncope: a prospective, randomized, crossover evaluation of the effect of propranolol, nadolol and placebo on syncope recurrence and patient’s well-being. J Am Coll Cardiol 40:499–504PubMedCrossRefGoogle Scholar
  10. 10.
    Petersen MEV, Chamberlain-Webber R, Fitzpatrick AP et al (1994) Permanent pacing for cardioinhibitory malignant vasovagal syndrome. Br Heart J 71:274–281PubMedCrossRefGoogle Scholar
  11. 11.
    Benditt DG, Petersen M, Lurie KG et al (1995) Cardiac pacing for the prevention of recurrent vasovagal syncope. Ann Intern Med 122:204–209PubMedGoogle Scholar
  12. 12.
    Connolly SJ, Sheldon R, Roberts RS et al (1999) The North American Vasovagal Pacemaker Study (VPS): a randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. J Am Coll Cardiol 33:6–20Google Scholar
  13. 13.
    Sutton R, Brignole M, Menozzi C et al (2000) Dual-chamber pacing in the treatment of neurally mediated tilt-positive cardioinhibitory syncope. Pacemaker versus no therapy: a multicentre, randomized study. Circulation 102:294–299Google Scholar
  14. 14.
    Ammirati F, Colivicchi F, Santini M et al (2001) Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope. Circulation 104:52–57PubMedCrossRefGoogle Scholar
  15. 15.
    Connolly SJ, Sheldon R, Thorpe KE et al (2003) Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope (VPS II): a randomized trial. JAMA 289:2224–2229PubMedCrossRefGoogle Scholar
  16. Raviele A, Giada F, Menozzi C et al (2003) A randomized, double-blind, placebo-controlled study of permanent cardiac pacing for the treatment of recurrent tilt-induced vasovagal syncope. The Vasovagal Syncope and Pacing Trial (Synpace). Submitted for publicatioGoogle Scholar
  17. 17.
    Raviele A, Alboni P (1994) Syncope: an update on pathophysiology, diagnosis and therapy. G Ital Cardiol 24:1227–1260PubMedGoogle Scholar
  18. 18.
    Abboud FM (1986) Pathophysiology of hypotension and syncope. In: Hurst JW, Logue RB, Rackley CE et al (eds) The heart. Mc Graw-Hill, New York, pp 370–382Google Scholar
  19. 19.
    Sobel BE, Roberts R (1988) Hypotension and syncope. In: Braunwald E (ed) Heart disease. A textbook of cardiovascular medicine. Saunders, Philadelphia, pp 884–895Google Scholar
  20. 20.
    Benditt DG, Lurie KG, Adler SW (1995) Pathophysiology of neurally mediated syncope: peripheral and central mechanisms. In: Raviele A (ed) Cardiac arrhythmias. Springer, Berlin New York Milan, pp 102–109Google Scholar
  21. 21.
    Giada F, Raviele A, Gasparini G et al (2001) Efficacy of a patient-activated drug delivery system using phenylephrine as active drug in aborting tilt-induced syncope. Pacing Clin Electrophysiol 24:5 (abstract)CrossRefGoogle Scholar
  22. 22.
    Raviele A, Giada F, Brignole M et al (2000) Comparison of diagnostic accuracy of sublingual nitroglycerin test and low-dose isoproterenol test in patients with unexplained syncope. Am J Cardiol 85:1194–1198PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • A. Raviele
    • 1
  • F. Giada
    • 1
  1. 1.Department of CardiologyUmberto I HospitalMestre-VeniceItaly

Personalised recommendations