Author + information
- Received March 2, 2019
- Revision received August 26, 2019
- Accepted September 5, 2019
- Published online November 4, 2019.
- Zachary D. Goldberger, MD, MSa,∗ (, )@uwsmph,
- Bradley J. Petek, MDb,
- Michele Brignole, MDc,
- Win-Kuang Shen, MDd,
- Robert S. Sheldon, MD, PhDe,
- Monica Solbiati, MD, PhDf,
- Jean-Claude Deharo, MDg,
- Angel Moya, MD, PhDh and
- Mohamed H. Hamdan, MD, MBAa
- aDepartment of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- bDepartment of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- cDepartment of Cardiology, Ospedali Del Tigullio, Lavagna, Italy
- dDepartment of Cardiology, Mayo Clinic, Scottsdale, Arizona
- eDepartment of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
- fFondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
- gDepartment of Cardiology, L’hôpital de la Timone, Marseille, France
- hDepartment of Cardiology, Hospital Universitari Dexeus, Barcelona, Spain
- ↵∗Address for correspondence:
Dr. Zachary D. Goldberger, University of Wisconsin School of Medicine and Public Health, Division of Cardiovascular Medicine/Electrophysiology, 600 Highland Avenue, H4/5 Clinical Science Center, Madison, Wisconsin 53792-3248.
• Syncope is a common clinical entity with variable presentations, and often an elusive causal mechanism, even after extensive evaluation.
• The purpose of this review is to highlight both congruencies and differences between the most recent syncope guidelines (2017 ACC/AHA/HRS vs. 2018 ESC).
• Key differences in recommendations were noted in patients with conduction disease, reflex syncope, and orthostatic hypotension. However, many of the treatment recommendations were grossly similar.
• Randomized trials and further translational investigations are needed to strengthen recommendations that are currently supported only with minimal evidence, and in areas of discrepancy between the guidelines.
Syncope is a commonly encountered and challenging problem in medical practice. Presentations are variable, and the causal mechanism often remains elusive even after extensive (and often expensive) evaluation. Clinical practice guidelines have been developed to help guide the multidisciplinary approach necessary to diagnose and manage the broad spectrum of patients presenting with syncope. The American College of Cardiology/American Heart Association, in collaboration with the Heart Rhythm Society, published its first syncope guidelines in 2017. The European Society of Cardiology released the fourth iteration of its syncope guidelines in 2018. This review highlights the differences and congruencies between the 2 sets of recommendations, their implications for clinical practice, the remaining gaps in understanding, and areas of future research.
- bifascicular block
- clinical practice guidelines
- electrophysiological study
- implantable loop recorder
- orthostatic hypotension
- permanent pacemaker
- reflex syncope
Drs. Hamdan and Brignole have a financial interest in F2 Solutions, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 2, 2019.
- Revision received August 26, 2019.
- Accepted September 5, 2019.
- 2019 American College of Cardiology Foundation
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