SYNCOPE
Available online
Task Force Report
Guidelines on management (diagnosis and treatment)
of syncope*
Task Force on Syncope, European Society of Cardiology†: M. Brignole (Chairman),
P. Alboni, D. Benditt, L. Bergfeldt, J. J. Blanc, P. E. Bloch Thomsen, J. G. van Dijk,
A. Fitzpatrick, S. Hohnloser, J. Janousek, W. Kapoor, R. A. Kenny, P. Kulakowski,
A. Moya, A. Raviele, R. Sutton, G. Theodorakis and W. Wieling
Table of contents
Preamble – Scope of the document 1256 – Method 1257
Definition 1258
Brief overview of pathophysiology of syncope 1258
Classification 1259
Epidemiological considerations 1259
Prognostic stratification: identification of factors
predictive of adverse outcome 1260
Strategy of evaluation (flow chart) 1262
Initial evaluation (history, physical examination,
baseline electrocardiogram) 1264
Echocardiogram 1266
Carotid sinus massage 1266
Tilt testing 1268
Electrocardiographic monitoring (non-invasive
and invasive) 1271
Electrophysiological testing 1273
ATP test 1277
Ventricular signal-averaged electrocardiogram 1278
Exercise testing 1278
Cardiac catheterization and angiography 1279
Neurological and psychiatric evaluation 1279
Diagnostic yield and prevalence of causes
of syncope 1282
General principles 1282
Neurally-mediated reflex syncopal syndromes 1283
Orthostatic hypotension 1285
Cardiac arrhythmias as primary cause 1286
Structural cardiac or cardiopulmonary disease 1289
Vascular steal syndromes 1289
Metabolic 1290
Need for hospitalization 1290
Syncope in the older adult 1290
Syncope in paediatric patients 1292
Driving and syncope 1293
Glossary of uncertain terms 1293
Preamble
Scope of the document
The purpose of this document is to provide specific
recommendations on the diagnostic evaluation and
management of syncope. The document is divided into
four parts: (1) classification, epidemiology and prognosis;
(2) diagnosis; (3) treatment; and (4) special issues
in evaluating patients with syncope. Each part reviews
background information and summarizes the relevant
literature. The details of pathophysiology and mechanisms
of various aetiologies were considered to lie
outside the scope of this document. Although the document
encompasses many of the important aspects of
syncope, the panel recommendations focused on the
following main questions:
1. What are the diagnostic criteria for causes of
syncope?
2. What is the preferred approach to the diagnostic
work-up in various subgroups of patients with
syncope?
3. How should patients with syncope be risk stratified?
Correspondence: Michele Brignole, MD, FESC, Department of
Cardiology and Arrhythmologic Centre, Ospedali Riuniti, 16033
Lavagna, Italy.
*This document has been reviewed by members of the Committee
for Practice Guidelines (formerly Committee for Scientific and
Clinical Initiatives) and by the members of the Board of the
European Society of Cardiology (see Appendix 1), who approved
the document on 8 March 2001. The full text of this document is
available on the website of the European Society of Cardiology in
the section ‘Scientific Information’, Guidelines.
†For affiliations of Task Force members see Appendix 2.
0195-668X/01/221256+51 $35.00/0 2001 The European Society of Cardiology
4. When should patients with syncope be hospitalized?
5. Which treatments are likely to be effective in preventing
syncopal recurrences?
