Advertisement

Development of an Implantable Drug Delivery System for the Treatment of Vasovagal Syncope: a Dream or a Real Prospect?

  • A. Raviele
  • M. Brignole
  • C. Menozzi
  • F. Giada
  • A. Dorigo

Abstract

Syncope is a common clinical problem. It accounts for approximately 3% of all emergency room visits and for 1% of all hospital admissions [1]. Syncope has a vasovagal origin in the majority of non-hospitalized patients (about 70%) [1]. Vasovagal reaction may occur both in pediatric and adult patients and is characterized by sudden vasodilatation, bradycardia or both, with resultant hypotension and loss of consciousness.

Keywords

Vasovagal Syncope Vasovagal Reaction Futura Publishing Implantable Pump Fluoxetine Hydrochloride 
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, Alboni P (1994) Syncope: an update on pathophysiology, diagnosis and therapy. G Ital Cardiol 24: 1227–1260PubMedGoogle Scholar
  2. 2.
    Abboud FM (1986) Pathophysiology of hypotension and syncope. In: Hurst JW, Logue RB, Rackley CE et al (eds) The heart. McGraw Hill, New York, pp 370–382Google Scholar
  3. 3.
    Sobel BE, Roberts R (1988) Hypotension and syncope. In: Braunwald E (ed) Heart disease. A textbook of cardiovascular medicine. WB Saunders Co., Philadelphia, pp 884–895Google Scholar
  4. 4.
    Epstein SE, Stampfer M, Beiser GD (1968) Role of the capacitance and resistance vessels in vasovagal syncope. Circulation 37: 524–533PubMedCrossRefGoogle Scholar
  5. 5.
    Oberg B, Thoren P (1972) Increased activity in left ventricular receptors during hemorrhage or occlusion of caval veins in the cat-a possible cause of vasovagal reaction. Acta Physiol Scand 85: 164–173PubMedCrossRefGoogle Scholar
  6. 6.
    Thoren P (1979) Role of cardiac vagal C fibers in cardiovascular control. Rev Physiol Biochem Pharmacol 86: 1–94PubMedCrossRefGoogle Scholar
  7. 7.
    Benditt DG, Lurie KG, Adler SW (1995) Pathophysiology of neurally mediated syncope: peripheral and central mechanisms. In: Raviele A (ed) Cardiac arrhythmias. Springer, Berlin, Heidelberg, pp 102–109Google Scholar
  8. 8.
    Raviele A, Themistoclakis S, Gasparini G (1996) Drug treatment of vasovagal syncope. In: Blanc JJ, Benditt D, Sutton R (eds) Neurally mediated syncope: pathophysiology, investigations and treatment. Futura Publishing Co., Armonk, NY, pp 113–117Google Scholar
  9. 9.
    Benditt DG, Petersen M, Lurie KG et al (1995) Cardiac pacing for prevention of recurrent vasovagal syncope. Ann Int Med 122: 204–209PubMedCrossRefGoogle Scholar
  10. 10.
    Benditt DG, Sutton R, Gammage MD et al (1997) Clinical experience with Thera DR rate-drop response pacing algorithm in carotid sinus syndrome and vasovagal syncope. PACE 20 (pt II): 832–839PubMedCrossRefGoogle Scholar
  11. 11.
    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
  12. 12.
    Kelly PA, Mann DE, Adler SW et al (1994) Low dose disopyramide often fails to prevent neurogenic syncope during head-up tilt testing. PACE 11: 1202–1206Google Scholar
  13. 13.
    Raviele A, Gasparini G, Di Pede F, Delise P, Bonso A, Piccolo E (1990) Usefulness of head-up tilt test in evaluating patients with syncope of unknown origin and negative electrophysiologic study. Am J Cardiol 65: 1322–1327PubMedCrossRefGoogle Scholar
  14. 14.
    Benditt DG, Lurie KG (1997) Sensors for early recognition of imminent vasovagal syncope. In: Raviele A (ed) Cardiac arrhythmias 1997. Springer, Berlin, Heidelberg, pp 428–434Google Scholar
  15. 15.
    Petersen MEV, Williams TR, Erickson M, Sutton R (1997) Right ventricular pressure, dP/dt, and preejection interval during tilt induced vasovagal syncope. PACE 20 (pt II): 806–809PubMedCrossRefGoogle Scholar
  16. 16.
    Brignole M, Menozzi C, Corbucci G, Garberoglio B, Plicchi G (1997) Detecting incipient vasovagal syncope: intraventricular acceleration. PACE 20 (pt II): 801–805PubMedCrossRefGoogle Scholar
  17. 17.
    Nappolz T (1994) Combination of drug delivery systems and implantable cardioverter-defibrillators: is there a possible marriage? In: Singor I (ed) Implantable cardioverter-defibrillator. Futura Publishing Co., Armonk, NY, pp 731–749Google Scholar
  18. 18.
    Sra JS, Murthy VS, Jazayeri MR et al (1992) Use of intravenous esmolol to predict efficacy of oral beta-adrenergic blocker therapy in patients with neurocardiogenic syncope. J Am Coll Cardiol 19: 402–407PubMedCrossRefGoogle Scholar
  19. 19.
    Arky R (1996) Physicians’ Desk Reference. Medical Economic Company at Montvale, NY, pp 2324–2325Google Scholar
  20. 20.
    Hengstmann JH, Goronzy J (1982) Pharmacokinetics of 3H phenylephrine in man. Eur J Clin Pharmacol 21: 335–341PubMedCrossRefGoogle Scholar
  21. 21.
    USPDI (1996) Drug information for the health care professional. 16th ed US Pharmaceutical Convention. Rockville, MDGoogle Scholar
  22. 22.
    Reynolds JEF (1993) Martindale: The extra Pharmacopoeia. The Pharmaceutical Press, London, pp 1251–1252Google Scholar
  23. 23.
    Weber JC, Gupta VD (1970) Stability of phenylephrine HC1 in intravenous solutions. Am J Hosp Pharm 28: 200Google Scholar

Copyright information

© Springer-Verlag Italia 1998

Authors and Affiliations

  • A. Raviele
    • 1
  • M. Brignole
    • 2
  • C. Menozzi
    • 3
  • F. Giada
    • 1
  • A. Dorigo
    • 4
  1. 1.Divisione di CardiologiaOspedale Umberto IMestre, VeniceItaly
  2. 2.Divisione di CardiologiaOspedale di LavagnaGenoaItaly
  3. 3.Divisione di CardiologiaOspedale di S. Maria NuovaReggio EmiliaItaly
  4. 4.Servizio di FarmaciaOspedale Umberto IMestre, VeniceItaly

Personalised recommendations