Suppression of sleep syncope and vagally-mediated asystole by norepinephrine transporter inhibitor, 2024, Satish R Raj et al

Key Teaching Points

• Recurrent vasovagal syncope is a widespread condition. The norepinephrine reuptake seems to have a role in the mechanism involved in vasovagal syncope.
• Atomoxetine 40 twice a day could be a possible medical treatment to reduce the frequency of asystole spells in patients suffering from recurrent vasovagal syncope.•
• Vasovagal sleep syncope is a rare condition and atomoxetine could have a role in the treatment of this condition.

Conclusion
This report is the first to directly link the clinical effectiveness of atomoxetine with its unusual ability to prevent vagally mediated asystole. It appears to suppress both sleep syncope and vagally mediated sinus node asystole. POST 7, a randomized controlled trial that tests whether atomoxetine suppresses VVS, is funded by the Canadian Institutes of Health Research and is underway (NCT05159687).

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