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Atomoxetine for suppression of vasovagal syncope

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Abstract

Objective

Vasovagal syncope (VVS) is a common clinical condition with few effective medical therapies. The study aimed to evaluate the effectiveness of atomoxetine in suppressing syncope in patients with recurrent VVS.

Methods

This was a retrospective, open-label, observational case series of 12 patients taking atomoxetine for suppression of recurrent vasovagal syncope. We compared syncope frequency in the 1 year before atomoxetine and while subjects were taking atomoxetine. We used novel applications of the Poisson distribution to describe the results as a collection of n = 1 studies.

Results

There were 12 subjects, eight female, with a mean age 47 ± 22 years and a mean Calgary Syncope Symptom Score of 2 (diagnostic of vasovagal syncope). The patients received a mean dose of atomoxetine of 66 ± 16 mg (1.06 ± 0.21 mg/kg). The mean follow-up period was 1.21 ± 1.01 years. While taking atomoxetine, 11/12 patients appeared to improve and 7/12 had no syncope in follow-up (p = 0.0046). The annualized syncope frequency decreased from a median 5.5 (IQR 4, 6.75) syncope per year to 0 (IQR 0, 0.88) syncope per year (p = 0.002, Wilcoxon rank-sum test). According to the Poisson distribution, 7/12 subjects significantly improved with p values of < 0.0001 to 0.0235, 3/12 did not faint but had too brief follow-up times to detect significance, and 2/12 did not improve significantly.

Conclusions

In this case series, atomoxetine was a promising oral agent for the prevention of vasovagal syncope. The Poisson distribution permits individual patient-level assessment of improvement and detects insufficient follow-up despite apparent improvement.

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Data availability

Data are available upon reasonable and reasoned request.

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Funding

This work was not funded externally.

Author information

Authors and Affiliations

  1. Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, GAA02 HRIC Building, 3280 Hospital Drive NW AB, Calgary, T2N 4Z6, Canada

    Robert S. Sheldon, Rasha Hamzeh & Satish R. Raj

  2. Cardiac Sciences Programme, University of Manitoba, Winnipeg, Canada

    Colette Seifer

  3. Department of Medicine, Dalhousie University, Halifax, Canada

    Ratika Parkash

  4. Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA

    Roopinder K. Sandhu

Authors
  1. Robert S. Sheldon
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  2. Colette Seifer
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  3. Ratika Parkash
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  4. Roopinder K. Sandhu
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  5. Rasha Hamzeh
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  6. Satish R. Raj
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Contributions

All authors contributed to the study conception and design. Data collection was performed by all authors. Data analysis and the first draft of the manuscript was written by Robert Sheldon and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Robert S. Sheldon.

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Conflict of interest

None of the authors has a financial conflict of interest related to this publication.

Ethical approval

This study was approved by the Calgary Conjoint Health Ethics Research Board (REB20-1937) and performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

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Sheldon, R.S., Seifer, C., Parkash, R. et al. Atomoxetine for suppression of vasovagal syncope. Clin Auton Res 33, 23–28 (2023). https://doi.org/10.1007/s10286-022-00905-x

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  • DOI: https://doi.org/10.1007/s10286-022-00905-x

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