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Effective treatment for vasovagal syncope, the most common type of syncope, has not been demonstrated in large randomized clinical trials. However, β-blockade is often used, on the basis of data from small nonrandomized trials. In a new, partly industry-supported, multinational trial, researchers randomized 208 patients (mean age, 42) with histories of recurrent vasovagal syncope to receive the β-blocker metoprolol (target dose, 100 mg twice daily) or placebo for 1 year. All had had positive responses to tilt testing.
During follow-up, syncope recurred in 75 patients. Recurrence rates were similar with metoprolol and placebo in both intention-to-treat and on-treatment analyses. Metoprolol also showed no prevention benefit in prespecified sub…