Syncope: Investigation and treatment

Current Cardiology Reports

Volumn 4, Issue 5, 2002, Pages 363-370

  Raj, Satish R ^a   Sheldon, Robert S ^a  

^a UNIVERSITY OF CALGARY   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

HUMAN; REVIEW; SYNCOPE;

HUMANS; SYNCOPE;

EID: 0036719566     PISSN: 15233782     EISSN: 15343170     Source Type: Journal    
DOI: 10.1007/s11886-002-0035-3     Document Type: Article

References (66)

1. Savage DD, Corwin L, McGee DL, et al.: Epidemiologic features of isolated syncope: the Framingham Study. Stroke 1985, 16:626-629.
2. Lipsitz LA, Wei JY, Rowe JW: Syncope in an elderly, institutionalised population: prevalence, incidence, and associated risk. Q J Med 1985, 55:45-54.
3. Silverstein MD, Singer DE, Mulley AG, et al.: Patients with syncope admitted to medical intensive care units. JAMA 1982, 248:1185-1189.
4. Linzer M, Yang EH, Estes NA, et al.: Diagnosing syncope. Part 1: Value of history, physical examination, and electrocardiography. Clinical Efficacy Assessment Project of the American College of Physicians. Ann Intern Med 1997, 126:989-996.
5. Kapoor WN, Fortunato M, Hanusa BH, Schulberg HC: Psychiatric illnesses in patients with syncope. Am J Med 1995, 99:505-512.
6. Brignole M, Alboni P, Benditt D, et al.: Guidelines on management (diagnosis and treatment) of syncope. Eur Heart J 2001, 22:1256-1306.
7. Calkins H, Shyr Y, Frumin H, et al.: The value of the clinical history in the differentiation of syncope due to ventricular tachycardia, atrioventricular block, and neurocardiogenic syncope. Am J Med 1995, 98:365-373.
8. Hoefnagels WA, Padberg GW, Overweg J, et al.: Transient loss of consciousness: the value of the history for distinguishing seizure from syncope. J Neurol 1991, 238:39-43.
9. Alboni P, Brignole M, Menozzi C, et al.: Diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Cardiol 2001, 37:1921-1928. Historic features of syncope in patients with and without heart disease were determined from structured questionnaires administered to 341 patients.
10. Sheldon R, Rose MS, Ritchie D, et al.: Historical diagnostic criteria for syncope versus seizures [abstract]. Pacing Clin Electrophysiol 2000, 23:601. From a 118-item historic questionnaire administered to 671 patients, this is the first report of a diagnostic point score based on historic criteria that can be used to discriminate between syncope and seizures.
11. Sheldon R, Rose MS, Ritchie D, et al.: Anamnestic diagnostic criteria for tilt-positive vasovagal syncope [abstract]. Pacing Clin Electrophysiol 2000, 23:643.
12. Sheldon RS, Rose MS, Fisher M, et al.: Historical criteria for the causes of syncope in patients with structural heart disease [abstract]. Pacing Clin Electrophysiol 2001, 24:627.
13. Munro NC, McIntosh S, Lawson J, et al.: Incidence of complications after carotid sinus massage in older patients with syncope. J Am Geriatr Soc 1994, 42:1248-1251.
14. Puggioni E, Guiducci V, Brignole M, et al.: Results and complications of the carotid sinus massage performed according to the "method of symptoms". Am J Cardiol 2002, 89:599-601.
15. Linzer M, Yang EH, Estes NA, et al.: Diagnosing syncope. Part 2: Unexplained syncope. Clinical Efficacy Assessment Project of the American College of Physicians. Ann Intern Med 1997, 127:76-86.
16. Krumholz HM, Douglas PS, Goldman L, Waksmonski C: Clinical utility of transthoracic two-dimensional and Doppler echocardiography. J Am Coll Cardiol 1994, 24:125-131.
17. Recchia D, Barzilai B: Echocardiography in the evaluation of patients with syncope. J Gen Intern Med 1995, 10:649-655.
18. Schnipper JL, Kapoor WN: Diagnostic evaluation and management of patients with syncope. Med Clin North Am 2001, 85:423-456, xi.
19. Sra JS, Jazayeri MR, Avitall B, et al.: Comparison of cardiac pacing with drug therapy in the treatment of neurocardiogenic (vasovagal) syncope with bradycardia or asystole. N Engl J Med 1993, 328:1085-1090.
20. Krahn AD, Klein GJ, Yee R, Manda V: The high cost of syncope: cost implications of a new insertable loop recorder in the investigation of recurrent syncope. Am Heart J 1999, 137:870-877.
21. Krahn AD, Klein GJ, Yee R, Skanes AC: Randomized assessment of syncope trial: conventional diagnostic testing versus a prolonged monitoring strategy. Circulation 2001, 104:46-51. This is the first randomized trial of a prolonged monitoring strategy (with an implantable loop recorder) versus a conventional diagnostic cascade for patients with unexplained syncope. The implantable loop recorder resulted in a diagnosis in 55% of patients compared with only 19% for the conventional strategy.
22. Krahn AD, Klein GJ, Yee R, Skanes AC: Predictive value of presyncope in patients monitored for assessment of syncope. Am Heart J 2001, 141:817-821.
23. Moya A, Brignole M, Menozzi C, et al.: Mechanism of syncope in patients with isolated syncope and in patients with tilt-positive syncope. Circulation 2001, 104:1261-1267. Using implantable loop recorders, investigators found that syncope patients with a structurally normal heart were similar in follow-up whether their tilt table test was positive or negative.
24. Sheldon R, Rose S, Koshman ML: Comparison of patients with syncope of unknown cause having negative or positive tilt-table tests. Am J Cardiol 1997, 80:581-585.
25. Brignole M, Menozzi C, Moya A, Garcia-Civera R, Mont L, Alvarez M, Errazquin F, Beiras J, Bottoni N, Donateo P: Mechanism of syncope in patients with bundle branch block and negative electrophysiological test. Circulation 2001, 104:2045-2050. Using implantable loop recorders, the investigators found that a large number of patients with a bundle branch block and a negative electrophysiologic study develop paroxysmal high-grade atrioventricular block.
26. Olshansky B, Hahn EA, Hartz VL, et al.: Clinical significance of syncope in the electrophysiologic study versus electrocardiographic monitoring (ESVEM) trial. The ESVEM Investigators. Am Heart J 1999, 137:878-886.
27. Middlekauff HR, Stevenson WG, Stevenson LW, Saxon LA: Syncope in advanced heart failure: high risk of sudden death regardless of origin of syncope. J Am Coll Cardiol 1993, 21:110-116.
28. Davidson E, Rotenbeg Z, Fuchs J, et al.: Transient ischemic attack-related syncope. Clin Cardiol 1991, 14:141-144.
29. Fitzpatrick AP, Theodorakis G, Vardas P, Sutton R: Methodology of head-up tilt testing in patients with unexplained syncope. J Am Coll Cardiol 1991, 17:125-130.
30. Benditt DG, Ferguson DW, Grubb BP, et al.: Tilt table testing for assessing syncope. American College of Cardiology. J Am Coll Cardiol 1996, 28:263-275.
31. Sheldon R, Killam S: Methodology of isoproterenol-tilt table testing in patients with syncope. J Am Coll Cardiol 1992, 19:773-779.
32. Raviele A, Menozzi C, Brignole M, et al.: Value of head-up tilt testing potentiated with sublingual nitroglycerin to assess the origin of unexplained syncope. Am J Cardiol 1995, 76:267-272.
33. Gregoratos G, Cheitlin MD, Conill A, et al.: ACC/AHA Guidelines for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices: Executive Summary-a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation). Circulation 1998, 97:1325-1335.
34. Steinberg JS, Beckman K, Greene HL, et al.: Follow-up of patients with unexplained syncope and inducible ventricular tachyarrhythmias: analysis of the AVID registry and an AVID substudy. Antiarrhythmics Versus Implantable Defibrillators. J Cardiovasc Electrophysiol 2001, 12:996-1001.
35. Murgatroyd FM, Klein GJ, Krahn A, et al.: Undocumented syncope with inducible VT is as malignant as documented symptomatic VT/VF. A Canadian Implantable Defibrillator Study (CIDS) subgroup analysis [abstract]. Circulation 1998, 98:I-495.
36. Fruhwald FM, Eber B, Schumacher M, et al.: Syncope in dilated cardiomyopathy is a predictor of sudden cardiac death. Cardiology 1996, 87:177-180.
37. Sager PT, Choudhary R, Leon C, et al.: The long-term prognosis of patients with out-of-hospital cardiac arrest but no inducible ventricular tachycardia. Am Heart J 1990, 120:1334-1342.
38. Fonarow GC, Feliciano Z, Boyle NG, et al.: Improved survival in patients with nonischemic advanced heart failure and syncope treated with an implantable cardioverter-defibrillator. Am J Cardiol 2000, 85:981-985.
39. Knight BP, Goyal R, Pelosi F, et al.: Outcome of patients with nonischemic dilated cardiomyopathy and unexplained syncope treated with an implantable defibrillator. J Am Coll Cardiol 1999, 33:1964-1970.
40. Eagle KA, Black HR, Cook EF, Goldman L: Evaluation of prognostic classifications for patients with syncope. Am J Med 1985, 79:455-460.
41. Sheldon R, Koshman ML: Can patients with neuromediated syncope safely drive motor vehicles? Am J Cardiol 1995, 75:955-956.
42. Morillo CA, Leitch JW, Yee R, Klein GJ: A placebo-controlled trial of intravenous and oral disopyramide for prevention of neurally mediated syncope induced by head-up tilt. J Am Coll Cardiol 1993, 22:1843-1848.
43. Sheldon RS: Outcome of patients with neurally mediated syncope following tilt table testing. Cardiologia 1997, 42:795-802.
44. Natale A, Geiger MJ, Maglio C, et al.: Recurrence of neurocardiogenic syncope without pharmacologic interventions. Am J Cardiol 1996, 77:1001-1003.
45. Sheldon R, Rose S, Flanagan P, et al.: Risk factors for syncope recurrence after a positive tilt-table test in patients with syncope. Circulation 1996, 93:973-981.
46. Sheldon R, Rose S, Flanagan P, et al.: Effect of beta blockers on the time to first syncope recurrence in patients after a positive isoproterenol tilt table test. Am J Cardiol 1996, 78:536-539.
47. Malik P, Koshman ML, Sheldon R: Timing of first recurrence of syncope predicts syncopal frequency after a positive tilt table test result. J Am Coll Cardiol 1997, 29:1284-1289.
48. Balaji S, Oslizlok PC, Allen MC, et al.: Neurocardiogenic syncope in children with a normal heart. J Am Coll Cardiol 1994, 23:779-785.
49. Mangru NN, Young ML, Mas MS, et al.: Usefulness of tilt table test with normal saline infusion in management of neurocardiac syncope in children. Am Heart J 1996, 131:953-955.
50. Scott WA, Pongiglione G, Bromberg BI, et al.: Randomized comparison of atenolol and fludrocortisone acetate in the treatment of pediatric neurally mediated syncope. Am J Cardiol 1995, 76:400-402.
51. Cox MM, Perlman BA, Mayor MR, et al.: Acute and long-term beta-adrenergic blockade for patients with neurocardiogenic syncope. J Am Coll Cardiol 1995, 26:1293-1298.
52. Mahanonda N, Bhuripanyo K, Kangkagate C, et al.: Randomized double-blind, placebo-controlled trial of oral atenolol in patients with unexplained syncope and positive upright tilt table test results. Am Heart J 1995, 130:1250-1253.
53. Madrid AH, Ortega J, Rebollo JG, et al.: Lack of efficacy of atenolol for the prevention of neurally mediated syncope in a highly symptomatic population: a prospective, doubleblind, randomized and placebo-controlled study. J Am Coll Cardiol 2001, 37:554-559. Double-blind, placebo-controlled, randomized trial showed that atenolol was not effective in preventing vasovagal syncope.
54. Sheldon RS, Raj SR, Rose S, Connolly SJ: Beta-blockers in syncope: the jury is still out. J Am Coll Cardiol 2001, 38:2135-2136.
55. Raviele A, Brignole M, Sutton R, et al.: Effect of etilefrine in preventing syncopal recurrence in patients with vasovagal syncope: a double-blind, randomized, placebo-controlled trial. The Vasovagal Syncope International Study. Circulation 1999, 99:1452-1457.
56. Perez-Lugones A, Schweikert R, Pavia S, et al.: Usefulness of midodrine in patients with severely symptomatic neurocardiogenic syncope: a randomized control study. J Cardiovasc Electrophysiol 2001, 12:935-938.
57. Di Girolamo E, Di Iorio C, Sabatini P, et al.: Effects of paroxetine hydrochloride, a selective serotonin reuptake inhibitor, on refractory vasovagal syncope: a randomized, double-blind, placebo-controlled study. J Am Coll Cardiol 1999, 33:1227-1230.
58. Di Girolamo E, Di Iorio C, Leonzio L, et al.: Usefulness of a tilt training program for the prevention of refractory neurocardiogenic syncope in adolescents: a controlled study. Circulation 1999, 100:1798-1801. Nonrandomized trial showed that a physical maneuver, orthostatic training (tilt training), could eliminate syncope recurrence in patients with frequent vasovagal syncope.
59. Ector H, Reybrouck T, Heidbuchel H, et al.: Tilt training: a new treatment for recurrent neurocardiogenic syncope and severe orthostatic intolerance. Pacing Clin Electrophysiol 1998, 21:193-196.
60. Connolly SJ, Sheldon R, Roberts RS, Gent M: The North American Vasovagal Pacemaker Study (VPS). A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. J Am Coll Cardiol 1999, 33:16-20. First large, randomized trial of dual-chamber pacing for vasovagal syncope. Pacing decreased the likelihood of syncope by 85%.
61. Sutton R, Brignole M, Menozzi C, et al.: Dual-chamber pacing in the treatment of neurally mediated tilt-positive cardioinhibitory syncope: pacemaker versus no therapy: a multicenter randomized study. The Vasovagal Syncope International Study (VASIS) Investigators. Circulation 2000, 102:294-299.
62. Ammirati F, Colivicchi F, Santini M: Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope : a multicenter, randomized, controlled trial. Circulation 2001, 104:52-57.
63. Raviele A, Giada F, Sutton R, et al.: The vasovagal Syncope and pacing (Synpace) trial: rationale and study design. Europace 2001, 3:336-341.
64. Brennan FJ, Mitchell LB, Sheldon RS, et al.: Assessment of the cardiac patient for fitness to drive: 1996 update. Can J Cardiol 1996, 12:1164-1170.
65. Epstein AE, Miles WM, Benditt DG, et al.: Personal and public safety issues related to arrhythmias that may affect consciousness: implications for regulation and physician recommendations. A medical/scientific statement from the American Heart Association and the North American Society of Pacing and Electrophysiology. Circulation 1996, 94:1147-1166.
66. Petch MC: Driving and heart disease. Eur Heart J 1998, 19:1165-1177.