Establishing the Efficacy of Midodrine to Prevent Vasovagal Syncope
Authors: Michele Brignole
Journal: Annals of Internal Medicine (2021)

EditorialsOctober 2021Establishing the Efficacy of Midodrine to Prevent Vasovagal SyncopeMichele Brignole, MDMichele Brignole, MDIstituto Auxologico Italiano, San Luca Hospital, Milan, ItalySearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-2859 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail This issue contains good news from the POST (Prevention of Syncope Trial) collaborative group trialists. After the POST 2 trial showed the efficacy of fludrocortisone in preventing vasovagal syncope (1), they now report the efficacy of midodrine in a well-powered, multicenter, randomized, double-blind, placebo-controlled trial (2). These researchers deserve congratulations.In brief, the trial showed that among patients who were young (median age of 32 years with a history of syncopal episodes starting at age 17 years), healthy (no comorbid conditions), and severely symptomatic (median of 6 episodes of vasovagal syncope in the prior year), 5 mg of midodrine administered ...References1. Sheldon R, Raj SR, Rose MS, et al; POST 2 Investigators. Fludrocortisone for the prevention of vasovagal syncope: a randomized, placebo-controlled trial. J Am Coll Cardiol. 2016;68:1-9. [PMID: 27364043] doi:10.1016/j.jacc.2016.04.030 CrossrefMedlineGoogle Scholar2. Sheldon R, Faris P, Tang A, et al. Midodrine for the prevention of vasovagal syncope. A randomized clinical trial. Ann Intern Med. 2021;174:1349-1356. doi:10.7326/M20-5415 Google Scholar3. Izcovich A, González Malla, Manzotti M, et al. Midodrine for orthostatic hypotension and recurrent reflex syncope: a systematic review. Neurology. 2014;83:1170-7. [PMID: 25150287] doi:10.1212/WNL.0000000000000815 CrossrefMedlineGoogle Scholar4. Raviele A, Brignole M, Sutton R, et al; Vasovagal Syncope International Study (VASIS) Investigators. Effect of etilefrine in preventing syncopal recurrence in patients with vasovagal syncope: a double-blind, randomized, placebo-controlled trial. Circulation. 1999;99:1452-7. [PMID: 10086969] CrossrefMedlineGoogle Scholar5. Brignole M, Rivasi G. New insights in diagnostics and therapies in syncope: a novel approach to non-cardiac syncope. Heart. 2021;107:864-873. [PMID: 33462120] doi:10.1136/heartjnl-2020-318261 CrossrefMedlineGoogle Scholar6. Brignole M, Donateo P, Tomaino M, et al; International Study on Syncope of Uncertain Etiology 3 (ISSUE-3) Investigators. Benefit of pacemaker therapy in patients with presumed neurally mediated syncope and documented asystole is greater when tilt test is negative: an analysis from the third International Study on Syncope of Uncertain Etiology (ISSUE-3). Circ Arrhythm Electrophysiol. 2014;7:10-6. [PMID: 24336948] doi:10.1161/CIRCEP.113.001103 CrossrefMedlineGoogle Scholar7. Brignole M, Russo V, Arabia F, et al; BioSync CLS trial Investigators. Cardiac pacing in severe recurrent reflex syncope and tilt-induced asystole. Eur Heart J. 2021;42:508-516. [PMID: 33279955] doi:10.1093/eurheartj/ehaa936 CrossrefMedlineGoogle Scholar8. Brignole M, Iori M, Solari D, et al. Efficacy of theophylline in patients with syncope without prodromes with normal heart and normal ECG. Int J Cardiol. 2019;289:70-73. [PMID: 30928258] doi:10.1016/j.ijcard.2019.03.043 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Michele Brignole, MDAffiliations: Istituto Auxologico Italiano, San Luca Hospital, Milan, ItalyDisclosures: The author has reported no disclosures of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-2859.Corresponding Author: Michele Brignole, MD, Istituto Auxologico Italiano, via Magnasco 2, 20149 Milan, Italy; e-mail, m.brignole@auxologico.it.This article was published at Annals.org on 3 August 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMidodrine for the Prevention of Vasovagal Syncope Robert Sheldon , Peter Faris , Anthony Tang , Felix Ayala-Paredes , Juan Guzman , Manlio Marquez , Carlos A. Morillo , Andrew D. Krahn , Teresa Kus , Debbie Ritchie , Shahana Safdar , Connor Maxey , and Satish R. Raj , for the POST 4 investigators Metrics October 2021Volume 174, Issue 10Page: 1460-1461KeywordsAbsolute risk reductionConfidence intervalsHazard ratioHospital medicineHypertensionIntent to treat analysisPatientsRelative risk ePublished: 3 August 2021 Issue Published: October 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...