[Comparison of metoprolol vs clonazepam as a first treatment choice among patients with neurocardiogenic syncope]

Author(s): Marquez MF, Urias-Medina K, Gomez-Flores J, Sobrino A, Sotomayor-Gonzalez A, Gonzalez-Hermosillo A, Cardenas M

Affiliation(s): Departamento de Electrocardiologia, Instituto Nacional de Cardiologia Ignacio Chavez, SSA, Tlalpan, Mexico DF, Mexico. manliomarquez@yahoo.com

Publication date & source: 2008-11, Gac Med Mex., 144(6):503-7.

Publication type: English Abstract

OBJECTIVE: We compared the effects of a metoprolol and clonazepam in patients with neurocardiogenic syncope. METHODS: We compared the effects of a metoprolol and clonazepam in a prospective, randomised trial in 54 patients. Patients were randomly assigned to metoprolol (starting dose 50 mg bid) or clonazepam (starting dose 0.5 mg qd). We assessed a primary combined endpoint of syncope and pre-syncope on a follow-up of 12 months. RESULTS: The primary combined endpoint of syncope and presyncope occurred in the metoprolol group in 3, 4, and 10% of patients at 3, 6, and 12 months respectively. In the clonazepam group it was no recurrence in the first 6 months, and 5% recurrence at 12 months follow-up (nonsignificant differences between groups). Clinical symptoms commonly associated with neurally mediated syncope were decreased similarly in both treatment groups, in the metoprolol group from 5.2+/-2.5 to 1.9+/-2.1 (p < 0.001) and in the clonazepam group from 5.5+/-2.5 to 1.5+/-2.2 (p<0.001). CONCLUSIONS: Pharmacological treatment of neurocardiogenic syncope with metoprolol or clonazepam resulted in similar prevention of syncope and presyncope. Both treatments decreased clinical symptoms but complete symptomatic resolution was rarely observed.