Clinical efficacy of beta1 selective adrenergic blockers in the treatment of neurocardiogenic syncope - a meta-analysis

Background: Beta1 (B-1) selective blockers have been widely used for the treatment of neurocardiogenic syncope though clinical trials have shown conflicting degrees of efficacy. Objective: To study the clinical efficacy of B-1 selective blockers compared to placebo in the treatment of neurocardiogenic syncope. Methods: Four placebo controlled randomized studies were identified after search of existing English language literature. Review Manager (RevMan version 5, Oxford, England) was used for statistical calculations. Both random and fixed effects models were used for analysis. Results: There was no demonstrable efficacy of B-1 blockers compared to placebo even after a pre-specified sensitivity analysis. There was a trend towards more adverse events in the beta blocker group compared to placebo (OR = 2.03 CI = 0.83-3.95, p = 0.12). Conclusion: There is no clinical evidence for justifying the use of B-1 selective blockers in the treatment of adult neurocardiogenic syncope. These agents may in fact lead to a higher rate of adverse events compared to placebo.