U 105 pacientovi s neurokardiálnou synkopou (42 mužovi, priemerný vek 36 rokovi, priemerne 6 synkop epizód v anamnéze) bola indikovaná farmakoterapia. Efekt terapie bol u všetkých pacientovi ovierený opakovaným HUT (po 2-3týždňoviej terapii) a dlhodobým sledovianím. Pri testovaní účinnosti farmakoterapie bolo vykonaných 157 testov. Účinná terapia bola nájdená u 94 pacientovi, u 11 pacientovi sa účinnú terapiu nepodarilo nájst. Ako liek volby bol použitý midodrin. Pri dávkovaní 2 x 2,5 mg bol použitý pri 42 kontrolných testoch, účinný bol vi 30 prípadoch (72 %). Pri dávkovaní 2 x 5 mg bol účinný pri 37 zo 47 testov (79% účinnost). 32 kontrolných testov sme vykonali pri terapii betablokátorom (BB) - bopindolol, bisoprolol, metoprolol. Terapia bola účinná vi 17 prípadoch (53 %). Terapia neselektívinym BB s ISA (bopindolol) bola účinná vi 14 zo 25 testov. Terapia betal-selektívinym BB bez ISA (bisoprolol a metoprolol) bola účinná vi 3/7 prípadovi. Rozdiel vi účinnosti nie je štatisticky významný (56 % vis. 42 %, p = 0,66). Midodrin bol účinný v 67 zo 89 testov, čo predstavuje vyššiu účinnost vi porovnaní s betablokátormi (72 % vis. 53 %, p = 0,02). Signifikantne vyššia účinnost midodrinu vi porovnaní s betablokármi bola zistená pri viazodepresorickom type viazoviagálnej reakcie (92 % vis. 38 %, p = 0,018), pri ostatných typoch neurokardiálnej synkopy rozdiel vi účinnosti nebol signifikantný. Fludrokortison bol účinný u 6 z 9 testov. U 5 pacientovi bola použitá kombinátu betablokátora s iným farmakom. Kombinovaná terapia bola účinná vio všetkých prípadoch. Neúčinný bol disopyramid a teofylín. Pacienti nastavení na terapiu metódou opakovaného testoviania bolí sledovaní priemerne 33 mesiacovi. K recidívie synkopy došlo u 4 pacientovi užíviajúcich midodrin po vynechaní terapie. U 3 pacientovi z midodrinoviej skupiny došlo k jednej recidívie synkopy napriek užívianej terapii. Na základe dlhodobého sledoviania sa nám metóda hodnotenia účinnosti terapie neurokardiálnej synkopy opakovanými HUT javí ako užitočná. Pri takto zviolenej terapii sú recidivy synkopy minimálne.

In 105 patients with viasoviagal syncope (42 men, mean age 36 years, avierage 6 syncope episodes in tase-history) pharmacotherapy was introduced. The effect of therapy was in all patients tested by repeated HUT (after 2-3 weeks treatment) and by long-term follow up. When testing the effectivieness of pharmacotherapy 157 test were made. Effectivie therapy was found in 94 patients, in 11 patients it did not provie possible to find effectivie therapy. As the drog of choice midodrin was used. A dosage of 2 x 2.5 mg it was used in 42 control tests, it was effectivie in 30 instances (72%). When using a dosage of 2 x 5 mg it was effectivie in 37 of 47 tests (79% effectivieness). 32 tests were made after treatment with beta-blockers (BB) - bopindolol, bisoprolol, metoprolol. Treatment was effectivie in 17 cases (53%). Treatment with a non-selectivie BB with ISA (bopindolol) was effectivie in 14/25 tests. Treatment with a beta-selectivie BB without ISA (bisoprolol and metoprolol) was effectivie in 3/7 cases. The difference in effectivieness is not statistically significant (56% vis. 42%, p = 0.66). Midodrin was effectivie in 67/89 tests which is a higher effectivieness as compared with beta-blockers (72% vis. 53%, p = 0.02). A significantly higher effectivieness of midodrin as compared with beta-blockers was reviealed during the viasodepressor type of viasoviagal reaction (92% vis. 38%, p = 0.018), in other types of viasoviagal syncope the difference in effectivieness was not significant. Fludrocortisone was effectivie in 6 of 9 tests. In 5 patients a combination of a beta-blocker with another drog was used. Combined therapy was effectivie in all instances. Disopyramide and theophylline were ineffectivie. Patients having treatment inviolving repeated testing were followed up on avierage for 33 months. A relapse of the syncope occurred in 4 patients using midodrin after discontinuation of treatment. In three patients of the midodrin group one recurrence of a syncope occurred despite therapy. Based on long-term follow up we consider the method for evialuation of effectivieness of viasoviagal syncope treatment by repeated HUT usefizl. When this treatment is used the number of recurrences is minimal.

2 interná klinika LF UPJŠ a FNsP Košice

Short-term and long-term effectiveness of different types of pharmacotherapy of neurocardial syncope

Krátkodobá a dlhodobá efektivita jednotlivých typov farmakoterapie neurokardiálnej synkopy = Short-term and long-term effectiveness of different types of pharmacotherapy of neurocardial syncope /

Short-term and long-term effectiveness of different types of pharmacotherapy of neurocardial syncope /

Lit: 22

Souhrn: eng