Diagnosis and treatment of syncope

Heart

Volumn 93, Issue 1, 2007, Pages 130-136

  Brignole, Michele ^a  

^a DEPARTMENT OF CARDIOLOGY   (Italy)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIHYPERTENSIVE AGENT; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; CLONIDINE; DISOPYRAMIDE; EPHEDRINE; ETILEFRINE; FLUDROCORTISONE; MIDODRINE; SCOPOLAMINE; SEROTONIN UPTAKE INHIBITOR; THEOPHYLLINE;

ANAMNESIS; BLOOD PRESSURE MEASUREMENT; CLINICAL FEATURE; DIAGNOSTIC TEST; DRUG WITHDRAWAL; ELECTROCARDIOGRAM; ELECTROENCEPHALOGRAM; HEART ARRHYTHMIA; HEART DISEASE; HUMAN; ORTHOSTATIC BLOOD PRESSURE; ORTHOSTATIC HYPOTENSION; PACEMAKER; PRACTICE GUIDELINE; PREVALENCE; PRIORITY JOURNAL; REVIEW; SYNCOPE; TILTING;

DIAGNOSIS, DIFFERENTIAL; ELECTROCARDIOGRAPHY; HUMANS; SYNCOPE;

EID: 33846209468     PISSN: 13556037     EISSN: None     Source Type: Journal    
DOI: 10.1136/hrt.2005.080713     Document Type: Review

References (27)

1. Brignole M, Alboni P, Benditt D, et al. Guidelines on management (diagnosis and treatment) of syncope-Update 2004. Europace 2004;6:467-537.
2. Brignole M, Alboni P, Benditt D, et al. Guidelines on management (diagnosis and treatment) of syncope-Update 2004-Executive summary and recommendations. Eur Heart J 2004;25:2054-72. References 1 and 2 are important consensus documents describing a standardised strategy for the evaluation and the treatment of patients with syncope
3. Alboni P, Brignole M, Menozzi C, et al. The diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Cardiol 2001;37:1921-8.
4. Linzer M, Yang E, Estes M, et al. Diagnosing syncope. Part II: unexplained syncope. Ann Intern Med, 1997;127, 76-86.
5. Brignole M, Menozzi C, Bartoletti A, et al. A new management of syncope. Prospective systematic guideline-based evaluation of patients referred urgently to general hospitals. Eur Heart J 2006;27:78-82.
6. Ammirati F, Colivicchi F, Minardi G, et al. Hospital management of syncope: the OESIL study. G Ital Cardiol 1999;29:533-9.
7. Disertori M, Brignole M, Menozzi C, et al. Management of syncope referred for emergency to general hospitals. Europace 2003;5:283-91.
8. Farwell DJ, Sulke AN. Does the use of a syncope diagnostic protocol improve the investigation and management of syncope? Heart 2004;90:52-8.
9. Blanc JJ, L'Her C, Touiza A, et al. Prospective evaluation and outcome of patients admitted for syncope over 1 year period. Eur Heart J 2002;23:815-20.
10. Ammirati F, Colivicchi F, Santini M. Diagnosing syncope in the clinical practice. Implementation of a simplified diagnostic algorithm in a multicentre prospective trial-the OESIL 2 study (Osservatorio Epidemiologico delta Sincope nel Lazio). Eur Heart J 2000;21:935-40.
11. Ector H, Reybrouck T, Heidbuchel H, et al. Tilt training: a new treatment for recurrent neurocardiogenic syncope or severe orthostatic intolerance. Pacing Clin Electrophysiol 1998;21:193-6. The first description of a new therapy for vasovagal syncope-tilt training.
12. Brignole M, Croci F, Menozzi C, et al. Isometric arm counter-pressure maneuvers to abort impending vasovagal syncope. J Am Coll Cardiol 2002;40:2054-60.
13. Krediet P, van Dijk N, Linzer M, et al. Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation 2002;106:1684-9. The first description of another new therapy for vasovagal syncope-physical manoeuvres.
14. Brignole M, Menozzi C Gianfranchi L, et al. A controlled trial of acute and long-term medical therapy in tilt-induced neurally mediated syncope. Am J Cardiol 1992;70:339-42.
15. Sheldon R, Rose S, Flanagan P, et al. Effects of beta blockers on the time to first syncope recurrence in patients after a positive isoproterenol tilt table test. Am J Cardiol 1996;78:536-9.
16. Di Gerolamo E, Di Iorio C, Sabatini P, et al. Effects of different treatments vs no treatment on neurocardiogenic syncope. Cardiologia 1998;43:833-7.
17. Flevari P, Livanis E, Theodorakis G, et al. Vasovagal syncope: a prospective, randomized, cross-over evaluation of the effects of propranolol, nadolol and placebo on syncope recurrence and patients' well-being. J Am Coll Cardiol 2002;40:499-504.
18. Madrid A, Ortega I, Rebollo GJ, et al. Lack of efficacy of atenolol for the prevention of neurally-mediated syncope in highly symptomatic population: a prospective double-blind, randomized and placebo-controlled study. J Am Coll Cardiol 2001;37:554-7. Double-blind placebo-controlled trial showing no benefit of β-blocker treatment for vasovagal syncope.
19. Ventura R, Maas R, Zeidler D, et al. A randomized and controlled pilot trial of β-blockers for the treatment of recurrent syncope in patients with a positive or negative response to head-up tilt test. Pacing Clin Electrophysiol 2002;25:816-21.
20. 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;99:1452-7. Double-blind placebo-controlled trial showing no benefit of α-agonist drug treatment for vasovagal syncope.
21. Sutton R, Brignole M, Menozzi C, et al. Dual-chamber pacing in treatment of neurally-mediated tilt-positive cardioinhibitory syncope. Pacemaker versus no therapy: a multicentre randomized study. Circulation 2000;102:294-9.
22. Connolly SJ, Sheldon R, Roberts RS, et al. Vasovagal pacemaker study investigators. 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.
23. Ammirati F, Colivicchi F, Santini M, et al. Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope. A multicenter, randomized, controlled trial. Circulation 2001;104:52-7.
24. Connolly SJ, Sheldon R, Thorpe KE, et al, for the VPS II Investigators. Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope: Second Vasovagal Pacemaker Study (VPS II). JAMA 2003;289:2224-9. Double-blind placebo-controlled trial showing no benefit of cardiac pacing for tilt-positive unselected vasovagal syncope patients.
25. Raviele A, Giada F, Menozzi C, et al. A randomized, double blind placebo-controlled study of permanent cardiac pacing for the treatment of recurrent tilt-induced vasovagal syncope. The vasovagal syncope and pacing trial (SYNPACE). Eur Heart J 2004;25:1541-8.
26. Maya A, Brignole M, Menozzi C, et al. Mechanism of syncope in patients with isolated syncope and in patients with tilt-positive syncope. Circulation 2001;104:1261-7. This study, using an implantable loop recorder, showed that half of the patients with tilt-positive vasovagal syncope have a long asystolic pause at the time of the spontaneous syncope and that mere is no difference between these patients and those with tilt-negative isolated syncope.
27. Brignole M, Sutton R, Menozzi C, et al. Early application of an implantable loop recorder allows effective specific therapy in patients with recurrent suspected neurally-mediated syncope. Eur Heart J 2006;27:1085-92. This study showed that a strategy of early implantation of an implantable loop recorder and specific therapy delayed until documentation of the mechanism of syncope is safe and very effective.