alpha-Adrenoceptor agonists for the treatment of vasovagal syncope: a meta-analysis of worldwide published data

Acta Paediatr. 2009 Jul;98(7):1194-200. doi: 10.1111/j.1651-2227.2009.01289.x. Epub 2009 Apr 21.


Aim: The present study was aimed at evaluating present randomized controlled trials (RCTs) regarding the effect of alpha-adrenoceptor agonists on vasovagal syncope (VVS).

Methods: According to inclusion and exclusion criteria, articles were selected from medical electronic databases. RCTs were then assessed based on the Juni assessment, and meta-analysis was completed using the Review Manager 4.2 software. Indication to further evaluate effects was the recurrence of syncope during follow-up treatment or a response in the head-up tilt test (HUT) after treatment. The results were stated as odd ratio (OR), with a 95% confidence interval (CI) and a p < 0.05 significant level.

Results: In total, six RCTs were selected. Funnel plot analysis showed possible publication bias. Meta-analysis of the six RCTs, including all 165 patients in the treatment group and 164 patients in the control group, indicated that alpha-adrenoceptor agonists were more effective than placebos in treating VVS (OR = 0.21, 95% CI: 0.06-0.77, p = 0.02). The further, weighted independent t-test disclosed that the weighted mean percentage of responders for midodrine (76.3%+/- 7.7%) was significantly higher than that for etilefrine (65.5%+/- 15.4%) (t = 5.863, p < 0.001).

Conclusion: The currently published RCTs support that alpha-adrenoceptor agonists might be effective for VVS. Midodrine can be regarded as a better choice compared with etilefrine.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic alpha-Agonists / therapeutic use*
  • Etilefrine / therapeutic use
  • Humans
  • Midodrine / therapeutic use
  • Outcome Assessment, Health Care
  • Randomized Controlled Trials as Topic
  • Syncope, Vasovagal / drug therapy*


  • Adrenergic alpha-Agonists
  • Midodrine
  • Etilefrine