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EHRA Key References on Syncope

Latest update december 2012

Syncope and Bradycardia


Guidelines for the diagnosis and management of syncope (version 2009)
The Task Force for the Diagnosis and Management of Syncope of the
European Society of Cardiology (ESC)
Developed in collaboration with, European Heart Rhythm Association (EHRA),
Heart Failure Association (HFA), and Heart Rhythm Society (HRS)
European Heart Journal (2009) 30, 2631–2671

New concepts in the assessment of syncope.
Brignole M, Hamdan MH. J Am Coll Cardiol. 2012 May 1;59(18):1583-91.

This paper is a brief guidance on how to manage a patient with syncope based on the latest results. Paper focused on the standardised syncope assessment, with interactive decision-making, which decreases admission rate and unnecessary testing and improves diagnostic yield, thus reducing cost per diagnosis.

Pacemaker therapy in patients with neurally mediated syncope and documented asystole: Third International Study on Syncope of Uncertain Etiology (ISSUE-3): a randomized trial.
Brignole M, Menozzi C, Moya A, Andresen D, Blanc JJ, Krahn AD, Wieling W, Beiras X, Deharo JC, Russo V, Tomaino M, Sutton R; International Study on syncope of Uncertain etiology 3 (ISSUE-3) Investigators. Circulation. 2012 May 29;125(21):2566-71.

The article examines the efficacy of cardiac pacing for prevention of syncopal recurrences in patients with neurally mediated syncope. The authors find that dual-chamber permanent pacing is effective in reducing recurrence of syncope in patients severe asystolic neurally mediated syncope, and reduced the syncope recurrence

San Francisco Syncope Rule to predict short-term serious outcomes: a systematic review.
Saccilotto RT, Nickel CH, Bucher HC, Steyerberg EW, Bingisser R, Koller MT. CMAJ. 2011 Oct 18;183(15):E1116-26.

The article proposes a clinical decision rule for risk stratification of patients with syncope in the emergency unit across various populations and settings. The San Francisco Syncope Rule is applied only for patients in whom no cause of syncope is evident after initial evaluation in the emergency department.

Indications for the use of diagnostic implantable and external ECG loop recorders.
Task Force members: Michele Brignole (Chairperson), Lavagna, Italy; Panos Vardas
(Co-chairperson), Heraklion, Greece; Ellen Hoffman, Munich, Germany;
Heikki Huikuri, Oulu, Finland; Angel Moya, Barcelona, Spain; Renato Ricci, Rome,
Italy; Neil Sulke, Eastbourne, UK; Wouter Wieling, Amsterdam, The Netherlands
Europace (2009) 11, 671–687

Use of an implantable loop recorder to increase the diagnostic yield in unexplained syncope: results from the PICTURE registry.
Edvardsson N, Frykman V, van Mechelen R, Mitro P, Mohii-Oskarsson A, Pasquié JL, Ramanna H, Schwertfeger F, Ventura R, Voulgaraki D, Garutti C, Stolt P, Linker NJ; PICTURE Study Investigators. Europace. 2011 Feb;13(2):262-9.

The aim of the registry was to collect information on the use of the Reveal implantable loop recorder and to investigate its effectiveness in the diagnosis of unexplained recurrent syncope. The ILR revealed or contributed to establishing the mechanism of syncope in the vast majority of patients. ILR should be implanted early rather than late in the evaluation of unexplained syncope.