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Midodrine treatment in children with recurrent vasovagal syncope

Published online by Cambridge University Press:  07 January 2021

Denizhan Bagrul Open the ORCID record for Denizhan Bagrul [Opens in a new window] ,
Ibrahim Ece ,
Arzu Yılmaz ,
Fatih Atik  and
Ahmet Vedat Kavurt Open the ORCID record for Ahmet Vedat Kavurt [Opens in a new window]
Denizhan Bagrul*
Affiliation:
Department of Pediatric Cardiology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
Ibrahim Ece
Affiliation:
Department of Pediatric Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
Arzu Yılmaz
Affiliation:
Division of Pediatric Neurology, Ministry of Health, Ankara Education and Research Hospital, Ankara, Turkey
Fatih Atik
Affiliation:
Division of Pediatric Cardiology, Ministry of Health, Ankara Education and Research Hospital, Ankara, Turkey
Ahmet Vedat Kavurt
Affiliation:
Department of Pediatric Cardiology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
*
Author for correspondence: D. Bagrul, Department of Pediatric Cardiology, Ministry of Health Ankara City Hospital, Üniversiteler Mahallesi 1604, Cadde No 9 Çankaya, Ankara, Turkey. Tel: +90 (507) 940 93 99; Fax: +90(312) 552 99 82. E-mail: [email protected]
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Abstract

Background:

Vasovagal syncope is the most common cause of syncope in childhood and its treatment is not at a satisfactory level yet. We aimed to investigate patients who were diagnosed with vasovagal syncope, did not benefit from conventional treatment, received midodrine treatment, and to evaluate their response to midodrine treatment.

Methods:

Files of 24 patients who were diagnosed with recurrent vasovagal syncope, did not benefit from non-pharmacological treatments, and received midodrine treatment during June 2017–October 2019 were retrospectively analysed.

Results:

In total, 24 patients received a treatment dose of midodrine at 5 mg/day (2.5 mg BID) included in the study. The mean number of syncope was 5.75 ± 2.67 prior to treatment. Following treatment, the mean number of syncope was 0.42 ± 0.89. It was observed that syncope episodes did not recur in 17 patients, but it recurred in 4 out of 7 patients in the first 3 months of the treatment and did not recur in the following months. The episodes improved in two patients with an increase in the treatment dose, but the syncope episodes continued in only one patient.

Conclusion:

It was concluded that midodrine treatment was effective and safe in adolescents with recurrent vasovagal syncope.

Keywords

Syncopemidodrinevasovagal syncope
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 5 , May 2021 , pp. 817 - 821
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Thijs, RD, Wieling, W, Kaufmann, H, van Dijk, JG. Defining and classifying syncope. Clin Auton Res 2004; 14: 4–8.CrossRefGoogle ScholarPubMed
Lewis, DA, Dhala, A. Syncope in pediatric patients. Pediatr Clin North Am 1999; 46: 205–219.CrossRefGoogle Scholar
Brignole, M, Moya, A, de Lange, FJ, et al. ESC guidelines for the diagnosis and management of syncope. Eur Heart J 2018; 39: 1883–1948.CrossRefGoogle ScholarPubMed
Nair, N, Padder, FA, Kantharia, BK. Pathophysiology and management of neurocardiogenic syncope. Am J Manag Care 2003; 9: 327–334.Google ScholarPubMed
Van Dijk, N, Quartieri, F, Blanc, JJ, et al. Effectiveness of physical counterpressure manoeuvers in preventing vasovagal syncope: the Physical Counterpressure Manoeuvres Trial (PC-Trial). J Am Coll Cardiol 2006; 48: 1652–1657.CrossRefGoogle Scholar
Mitro, P, Trejbal, D, Rybar, R. Midodrine hydrochloride in the treatment of vasovagal syncope. Pacing Clin Electrophysiol 1999; 22: 1620–1624.CrossRefGoogle ScholarPubMed
Thulesius, O, Gjores, JE, Berlin, E. Vasoconstrictor effect of midodrine, ST 1059, noradrenaline, etilefrine and dihydroergotamine on isolated human veins. Eur J Glin Pharmacol 1979; 16: 423–424.CrossRefGoogle ScholarPubMed
Low, PA, Gilden, JL, Freeman, GR, et al. Efficacy of midodrine vs placebo in neurogenic orthostatic hypotension, a randomized, double- blind multicenter study. JAMA 1997; 277: 1046–1051.CrossRefGoogle ScholarPubMed
Jankovic, J, Gilden, JL, Hiner, BC, et al. Neurogenic orthostatic hypotension: a double - blind placebo - controlled study with midodrine. Am J Med 1993; 95: 38–48.CrossRefGoogle ScholarPubMed
Driscoll, DJ, Jacobsen, SJ, Porter, CJ, Wollan, PC. Syncope in children and adolescents. J Am Coll Cardiol 1997; 29: 1039–1045.CrossRefGoogle ScholarPubMed
Mosqueda-Garcia, R, Furlan, R, Tank, J, Fernandez-Violante, R. The elusive pathophysiology of neurally mediated syncope. Circulation 2000; 102: 2898–2906.CrossRefGoogle ScholarPubMed
Wieling, W, Jardine, DL, de Lange, FJ, et al. Cardiac output and vasodilation in the vasovagal response: an analysis of the classic papers. Heart Rhythm 2016; 13: 798–805.CrossRefGoogle ScholarPubMed
Wang, C, Li, Y, Liao, Y, Tian, H, Huang, M, Dong, X, et al. Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents. Sci Bull 2018; 63: 1558–1564.CrossRefGoogle Scholar
Mahanonda, N, Bhuripanjo, K, Kangkate, C, et al. Randomized, double-blind, placebo-controlled trial of oral atenolol in patients with unexplained syncope and positive upright tilt table test results. Am Heart J 1995; 130: 1250–1253.CrossRefGoogle ScholarPubMed
Ward, CR, Gray, JC, Gilroy, JJ, et al. Midodrine: a role in the management of neurocardiogenic syncope. Heart 1998; 79: 45–49.CrossRefGoogle ScholarPubMed
Di Girolamo, E, Di Iorio, C, Sabatini, P, et al. Effects of paroxetine hydrochloride, a selective serotonin reuptake inhibitor, on refractory vasovagal syncope: a randomized, double-blind, placebo-controlled study. J Am Coll Cardiol 1999; 33: 1227–1230.CrossRefGoogle ScholarPubMed
Connolly, SJ, Sheldon, R, Roberts, RS, et al. The North American Vasovagal Pacemaker Study (VPS): a randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. J Am Coll Cardiol 1999; 33: 16–20.10.1016/S0735-1097(98)00549-XCrossRefGoogle ScholarPubMed
Salim, MA, Di Sessa, TG. Effectiveness of fludrocortisone and salt in preventing syncope recurrence in children: a doubleblind, placebo-controlled, randomized trial. J Am Coll Cardiol 2005; 45: 484–488.CrossRefGoogle Scholar
Zhang, Q, Jin, H, Wang, L, Chen, J, Tang, C, Du, J. Randomized comparison of metoprolol versus conventional treatment in preventing recurrence of vasovagal syncope in children and adolescents. Med Sci Monit 2008; 14: 199–203.Google ScholarPubMed
Qingyou, Z, Junbao, D, Chaoshu, T. The efficacy of midodrine hydrochloride in the treatment of children with vasovagal syncope. J Pediatr 2006; 149: 777–780.CrossRefGoogle ScholarPubMed
Shen, WK, Sheldon, RS, Benditt, DG, et al. ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Circulation 2017; 136: 60–122.Google Scholar
Sanatani, S, Chau, V, Fournier, A, et al. Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association position statement on the approach to syncope in the pediatric patient. Can J Cardiol 2017; 33: 189–198.CrossRefGoogle Scholar
Sra, J, Maglio, C, Biehl, M, et al. Efficacy of midodrine hydrochloride in neurocardiogenic syncope refractory to standard therapy. J Cardiovasc Electrophysiol 1997; 8: 42–46.CrossRefGoogle ScholarPubMed
Zachariah, PK, Bloedow, DC, Moyer, TP, et al: Pharmacodynamics of midodrine, an antihypotensive agent. Clin Pharmacol Ther 1986; 39: 586–589.CrossRefGoogle ScholarPubMed
Grubb, BP, Karas, B, Kosinski, D, Boehm, K. Preliminary observations on the use of midodrine hydrochloride in the treatment of refractory neurocardiogenic syncope. J Interv Card Electrophysiol 1999; 3: 139–143.CrossRefGoogle ScholarPubMed
Kaufmann, H, Saadia, D, Voustianiouk, A. Midodrine in neurally mediated syncope: a double-blind, randomized, crossover study. Ann Neurol 2002; 52: 342–345.10.1002/ana.10293CrossRefGoogle ScholarPubMed
Romme, JJ, van Dijk, N, Go-Schon, IK, et al. Effectiveness of midodrine treatment in patients with recurrent vasovagal syncope not responding to non-pharmacological treatment (STAND-trial). Europace 2011; 13: 1639–1647.CrossRefGoogle Scholar