Refractory Vasovagal Syncope Despite Tilt Training: Should Paroxetine be Included in the Treatment?

BACKGROUND/AIMS: To investigate the efficacy of selective serotonin reuptake inhibitors (SSRI) for preventing spontaneous vasovagal syncope (VVS) in patients with refractory VVS despite home-based tilt training (TT). MATERIALS AND METHODS: We included 111 consecutive patients with VVS. All patients were instructed to increase salt and fluid intake, perform counterpressure maneuvers, and perform TT. The first control visit was scheduled within 2 months of the initial treatment. Paroxetine 20 mg was added to TT in patients with refractory VVS despite TT (TT plus SSRI group) at the first control visit, and patients without refractory VVS who continued TT (TT group). The clinical features of the patients, spontaneous VVS attacks before and after treatment, and follow-up data were recorded. RESULTS: A total of 111 consecutive patients (67 females; age: 32 +/- 12 years) were treated with TT (64 patients) or TT plus SSRI (47 patients). The mean follow-up was 8.9 +/- 3.3 months after the first control visit. During follow-up, 38 (80.9%) patients in the TT + SSRI group and 30 (46.9%) in the TT group were asymptomatic (p<0.001). In the univariate analyses, TT plus SSRI treatment and TT treatment during follow-up were predictors of an asymptomatic course. Multivariate analysis showed that TT plus SSRI therapy (odds ratio: 4,785, 95% confidence interval: 4,78411,501, p<0.001) as the sole predictor of asymptomatic course at follow-up. CONCLUSION: The addition of paroxetine to the treatment of patients with recurrent VVS who do not respond to TT and conventional treatment is an effective and well-tolerated treatment method for preventing vasovagal attacks.