Comparing Physical, Pharmacological, Pacemaker, and Cardioneuroablation Therapies for Patients with Vasovagal Syncope: A systematic review and network <i>meta</i>-analysis.

In the subgroup analysis of midodrine, β-blockers, and SSRIs (fluoxetine and paroxetine) versus placebo for spontaneous syncope recurrence, under the random-effects model, both midodrine and SSRIs showed a significant effect [midodrine: OR = 0.41, 95% CI (0.23, 0.74); SSRIs: OR = 0.27, 95% CI (0.13, 0.58)], whereas only β-blockers [OR = 0.78, 95% CI (0.31, 2.00)] did not reach statistical significance ( Fig. 4 ).In the subgroup analysis of different pacemaker modes versus placebo for spontaneous syncope recurrence, conventional pacing modes showed no significant difference [OR = 0.60, 95% CI (0.26, 1.42)], whereas the DDD-CLS (dual-chamber pacing with closed loop stimulation) mode demonstrated a significant advantage [OR = 0.13, 95% CI (0.07, 0.25)] ( Fig. 5 ).

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