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Vasovagal syncope is mediated through decreased preload and reduced cardiac output in association with the vasovagal reflex. To evaluate the effectiveness of fludrocortisone in preventing vasovagal syncope, researchers conducted a multicenter trial in which 210 patients with recurrent vasovagal syncope were randomized to receive fludrocortisone (dose titrated to 0.2 mg daily over 1–2 weeks) or placebo for 12 months. Mean age was 30, 71% were women, and participants averaged 15 previous syncopal episodes during 9 years.
In an intent-to-treat analysis, syncope recurred in 44% of fludrocortisone patients and in 60% of placebo patients — a nonsignificant difference (hazard ratio, 0.69; P=0.07). However, in an analysis of the 61% of patients who …