SynthesisHeart rhythm2020
Pharmacological norepinephrine transporter inhibition for the prevention of vasovagal syncope in young and adult subjects: A systematic review and meta-analysis.
Synthesis in Heart rhythm, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 28 citations in OpenAlex.
- Prevention of Blood Donation-related Vasovagal Response by Applied Muscle Tension: a Meta-analysis.The Journal of international medical research · 2022Pooled it
- Comparing Physical, Pharmacological, Pacemaker, and Cardioneuroablation Therapies for Patients with Vasovagal Syncope: A systematic review and networkInternational journal of cardiology. Heart & vasculature · 2026Article
- Roles of Single Nucleotide Polymorphisms in the SLC6A2 Gene in the Risk of Vasovagal Syncope Among Children in Eastern China: A Case-Control Study.Health science reports · 2025Article
- Application of predonation hydration for vasovagal reactions during blood donation: a bibliometric analysis (2004-2023).Frontiers in medicine · 2025Article
- The effects of vitamin B and D supplementations on autonomic functions and quality of life in children after vasovagal syncope.Frontiers in pediatrics · 2025Article
- Suppression of sleep syncope and vagally-mediated asystole by norepinephrine transporter inhibitor.HeartRhythm case reports · 2024Article
- Serotonin and vasovagal syncope.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2024Review
- Twenty-five years of research on syncope.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Article
- Effects of Atomoxetine for the Treatment of Neurogenic Orthostatic Hypotension in Patients With Alpha-synucleinopathies: A Systematic Review of Randomized Controlled Trials and a Focus-Group Discussion.Journal of clinical neurology (Seoul, Korea) · 2023Article
- How to unblur the vasovagal evidence?Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2023Article
- Atomoxetine for suppression of vasovagal syncope.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2023Observational
- Atomoxetine as an adjunct to nonpharmacological treatments for preventing vasovagal attacks in patients with recurrent vasovagal syncope: A pilot randomized-controlled trial.International journal of cardiology. Heart & vasculature · 2021Article
- Non-Pharmacological and Pharmacological Management of Cardiac Dysautonomia Syndromes.Journal of atrial fibrillationArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 1 institution in 1 country.
Funding
Abstract
backgroundVasovagal syncope (VVS) significantly reduces quality of life, yet lacks effective medical therapies. Pharmacological norepinephrine transporter (NET) inhibition increases synaptic norepinephrine reuptake, which may be able to prevent hypotension, bradycardia, and syncope.
objectiveThe objective of this systematic review was to evaluate the ability of 3 NET inhibitors-reboxetine, sibutramine, and atomoxetine-to prevent head-up tilt-induced vasovagal outcomes in healthy participants and patients with VVS.
methodsRelevant studies were identified from Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature without language restriction from database inception to August 2019. All randomized controlled trials comparing the benefit of a NET inhibitor vs placebo in adult populations were selected for review and meta-analysis.
resultsFour studies (101 participants) met inclusion criteria. The mean study size was 25 (range 11-56) participants. NET inhibition reduced the likelihood of vasovagal reactions marked by hypotension and bradycardia in healthy participants during head-up tilt testing (relative risk 0.15; 95% confidence interval 0.04-0.52; P = .003). This relative risk reduction also occurred in patients with VVS during head-up tilt when given atomoxetine (relative risk 0.49; 95% confidence interval 0.28-0.86; P = .01). This was achieved through heart rate compensation with NET inhibition toward the end of tilt testing (106 ± 32 beats/min vs 60 ± 22 beats/min; P < .001), which in turn preserved cardiac output and mean arterial pressure (71 ± 20 mm Hg vs 43 ± 13 mm Hg; P < .001) in the absence of significantly increased systemic vascular resistance.
conclusionNET inhibition prevents severe vasovagal reactions and syncope induced by head-up tilt testing in both healthy participants and patients with VVS. Pharmacological NET inhibition is a promising potential treatment of recurrent syncope.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.