Prof. Richard Sutton,
A Moya spoke about bundle branch block by reviewing the early literature and recent work including the B4 study, of which he was leader. It concluded that 83% of patients can be diagnosed by a 3-step process, initial evaluation (Syncope Guidelines 2009), Carotid sinus massage and electrophysiological study, and thirdly, loop recorder implantation. The recent PRESS study was assessed but new guidelines and B4 study were recommended for present management.
P Flevari approached tilt testing and autonomic assessment, concluding that careful observation of physiological parameters was necessary and this could be by any qualified enthusiast, cardiologist, neurologist etc. Furthermore, tilt testing still has much value to the clinician.
RoseAnne Kenny gave a dramatic view of the world picture of ageing and its impact on economics of countries and their healthcare. She pointed out that syncope is increasingly common in parallel with advancing age and is increasingly due to structural cardiovascular disease. She emphasized the importance of the history, but tempered this by demonstrating age-related amnesia for events preceding syncope.
The final speaker was Michele Brignole who made a strong case for widespread introduction of Syncope Units, showing also the requirements for their establishment. These Units, from what has already been published, provide the solution to the current difficulty in achieving adequate and widely acceptable risk stratification for the presentation of syncope.
Session Title: Diagnostic evaluation of syncope
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