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(Circulation. 2006;113:1164-1170.)
© 2006 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Prevention of Syncope Trial (POST)

A Randomized, Placebo-Controlled Study of Metoprolol in the Prevention of Vasovagal Syncope

Robert Sheldon, MD, PhD; Stuart Connolly, MD; Sarah Rose, PhD; Thomas Klingenheben, MD; Andrew Krahn, MD; Carlos Morillo, MD; Mario Talajic, MD; Teresa Ku, MD; Fetnat Fouad-Tarazi, MD; Debbie Ritchie, MN; Mary-Lou Koshman, RN, for the POST Investigators

From the University of Calgary, Calgary, Canada (R.S., S.R., D.R., M.-L.K.); McMaster University, Hamilton, Canada (S.C., C.M.); JW Goethe University, Frankfurt, Germany (T. Klingenheben); University of Western Ontario, London, Canada (A.K.); Fundacion Cardiovascular de Columbia, Bucaramanga, Columbia (C.M.); University of Montreal, Montreal, Canada (M.T., T. Ku); and the Cleveland Clinic, Cleveland, Ohio (F.F.-T.).

Correspondence to Dr Robert Sheldon, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada. E-mail sheldon{at}ucalgary.ca

Received October 29, 2005; revision received December 2, 2005; accepted December 15, 2005.

Background— Previous studies that assessed the effects of ß-blockers in preventing vasovagal syncope provided mixed results. Our goal was to determine whether treatment with metoprolol reduces the risk of syncope in patients with vasovagal syncope.

Methods and Results— The multicenter Prevention of Syncope Trial (POST) was a randomized, placebo-controlled, double-blind, trial designed to assess the effects of metoprolol in vasovagal syncope over a 1-year treatment period. Two prespecified analyses included the relationships of age and initial tilt-test results to any benefit from metoprolol. All patients had >2 syncopal spells and a positive tilt test. Randomization was stratified according to ages <42 and 42 years. Patients received either metoprolol or matching placebo at highest-tolerated doses from 25 to 200 mg daily. The main outcome measure was the first recurrence of syncope. A total of 208 patients (mean age 42±18 years) with a median of 9 syncopal spells over a median of 11 years were randomized, 108 to receive metoprolol and 100 to the placebo group. There were 75 patients with 1 recurrence of syncope. The likelihood of recurrent syncope was not significantly different between groups. Neither the age of the patient nor the need for isoproterenol to produce a positive tilt test predicted subsequent significant benefit from metoprolol.

Conclusions— Metoprolol was not effective in preventing vasovagal syncope in the study population.

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