Clinical Trial for the Prevention of Vasovagal Syncope
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Purpose
The main question in the study is whether people taking fludrocortisone are less likely to faint than people taking an inactive pill called a placebo.
Fludrocortisone is a drug that stimulates the body to retain salt and water. The investigators know from some studies that it might prevent people from fainting at home and in the community, while they are carrying on with their lives. There is some evidence that salt and water retention help prevent fainting, but no one has a clear idea about whether this is true. This study will try to determine if that is true.
| Condition | Intervention | Phase |
|---|---|---|
|
Syncope, Vasovagal, Neurally-Mediated |
Drug: fludrocortisone acetate |
Phase 4 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) Primary Purpose: Treatment |
| Official Title: | A Randomized Clinical Trial of Fludrocortisone for Vasovagal Syncope: The Second Prevention of Syncope Trial (POST II) |
- The primary outcome measure will be the time to the first recurrence of syncope. [ Time Frame: Within 12 months ] [ Designated as safety issue: No ]
- The frequency of syncope will be the first secondary outcome measure. [ Time Frame: Within 12 months ] [ Designated as safety issue: No ]
- Presyncope frequency, duration, and intensity will be the second secondary outcome measures, both alone and in a composite score. [ Time Frame: Within 12 months ] [ Designated as safety issue: No ]
- Quality of life will be the third secondary outcome measure. The investigators will compare the quality of life in treated and untreated patients. [ Time Frame: 12 months ] [ Designated as safety issue: No ]
| Enrollment: | 214 |
| Study Start Date: | May 2005 |
| Study Completion Date: | July 2011 |
| Primary Completion Date: | July 2011 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
| Experimental: fludrocortisone acetate |
Drug: fludrocortisone acetate
Fludrocortisone acetate to a maximum of 0.2 mg daily Placebo to a maximum of 0.2 mg daily
|
| Placebo Comparator: Placebo |
Drug: fludrocortisone acetate
Fludrocortisone acetate to a maximum of 0.2 mg daily Placebo to a maximum of 0.2 mg daily
|
Detailed Description:
About 10% of adults faint recurrently. These patients are often highly symptomatic, have problems with employment and driving, and have well-documented reduced quality of life. There are no therapies that have withstood the test of adequately conducted and credible randomized clinical trials.
There is ample evidence of the importance of blood volume in the pathophysiology of vasovagal syncope. Fludrocortisone acetate is a corticosteroid with a mild enhancement of glucocorticoid activity and a marked increase in mineralocorticoid activity. It has no appreciable glucocorticoid effect at doses between 0.05 to 0.2 mg, which are the commonly used clinical doses for various disorders requiring mineralocorticoid adrenal replacement. The acute actions of fludrocortisone acetate are sodium and water retention, at the expense of urinary potassium excretion. Blood volume expansion with either dietary salt supplementation or fludrocortisone is often recommended by clinicians for the treatment of vasovagal syncope despite a paucity of good evidence for their efficacy. Four clinical studies suggest its utility in the prevention of syncope. Fludrocortisone might decrease the incidence of vasovagal syncope, but the quality of the evidence supporting its use is poor. There are no randomized, placebo-controlled trials of fludrocortisone for the prevention of vasovagal syncope. In this 5-year study the investigators will test the hypothesis that fludrocortisone prevents recurrences of vasovagal syncope.
Eligibility| Ages Eligible for Study: | 14 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Syncope as a cause of loss of consciousness according to European Society of Cardiology criteria
- > 2 lifetime syncopal spells preceding enrollment
- > or = to -2 points on the Syncope Symptom Score for Structurally Normal Hearts
- Age > 18 years with informed consent, or age > 14 years with consent and informed parental consent
Exclusion Criteria:
- Other causes of syncope, such as ventricular tachycardia, complete heart block, postural (orthostatic) hypotension or hypersensitive carotid sinus syndrome
- An inability to give informed consent
- Important valvular, coronary, myocardial or conduction abnormality or significant arrhythmia
- Hypertrophic cardiomyopathy
- A known intolerance to fludrocortisone
- Another clinical need for fludrocortisone that cannot be met with other drugs
- A permanent pacemaker
- A seizure disorder
- A major chronic non cardiovascular disease
- Hypertension (blood pressure ≥ 130/85 on 2 occasions) or heart failure
- Renal dysfunction (baseline glomerular filtration rate reduced below 60 ml/min/1.73m2 according to the Cockroft-Gault formula)
- Diabetes mellitus
- Hepatic disease
- Glaucoma
- Any prior use of fludrocortisone acetate
- A 5-minute stand test resulting in diagnosis of postural orthostatic tachycardia syndrome or orthostatic hypotension
Contacts and Locations| United States, Massachusetts | |
| Boston University | |
| Boston, Massachusetts, United States, 02118 | |
| United States, Tennessee | |
| Vanderbilt University | |
| Nashville, Tennessee, United States, 37232-2195 | |
| United States, Virginia | |
| Virginia Cardiovascular Specialists | |
| Richmond, Virginia, United States, 23225-3838 | |
| Canada, Alberta | |
| University of Calgary, Faculty of Medicine | |
| Calgary, Alberta, Canada, T2N 4N1 | |
| Alberta Children's Hospital | |
| Calgary, Alberta, Canada, T3B 6A8 | |
| Canada, Manitoba | |
| St. Boniface General Hospital | |
| Winnipeg, Manitoba, Canada, R2H 2A6 | |
| Canada, Nova Scotia | |
| Queen Elizabeth II, Halifax Infirmary | |
| Halifax, Nova Scotia, Canada, B3H 3A7 | |
| Canada, Ontario | |
| McMaster University, Hamilton Health Sciences | |
| Hamilton, Ontario, Canada, L8L 2X2 | |
| Queen's University | |
| Kingston, Ontario, Canada, K7V 2V7 | |
| University of Western Ontario, London Health Sciences | |
| London, Ontario, Canada, N6A 5A5 | |
| University of Ottawa, Ottawa Heart Institute | |
| Ottawa, Ontario, Canada, K1Y 4W7 | |
| St. Michael's Hospital | |
| Toronto, Ontario, Canada, M5B 1W8 | |
| Canada, Quebec | |
| Hopital Sacre Coeur de Montreal | |
| Montreal, Quebec, Canada, H4J 1C5 | |
| Institut de Cardiologie de Montreal | |
| Montreal, Quebec, Canada, H1T 1C8 | |
| Principal Investigator: | Robert S. Sheldon, MD PhD | University of Calgary, Faculty of Medicine |
More Information
No publications provided
| Responsible Party: | Dr. Bob Sheldon, Professor of Cardiac Sciences, Medicine and Medical Genetics, University of Calgary |
| ClinicalTrials.gov Identifier: | NCT00118482 History of Changes |
| Other Study ID Numbers: | 130312, ISRCTN51802652 |
| Study First Received: | June 30, 2005 |
| Last Updated: | April 16, 2013 |
| Health Authority: | Canada: Health Canada United States: Food and Drug Administration |
Keywords provided by University of Calgary:
|
vasovagal syncope randomized clinical trial quality of life |
Additional relevant MeSH terms:
|
Syncope Syncope, Vasovagal Unconsciousness Consciousness Disorders Neurobehavioral Manifestations Neurologic Manifestations Nervous System Diseases Signs and Symptoms |
Orthostatic Intolerance Primary Dysautonomias Autonomic Nervous System Diseases Fludrocortisone Anti-Inflammatory Agents Therapeutic Uses Pharmacologic Actions |
ClinicalTrials.gov processed this record on June 18, 2013