Syncope Unit: rationale and requirement – the European Heart Rhythm Association position statement endorsed by the Heart Rhythm Society

Abstract

The European Society of Cardiology (ESC) has played an important role in advancing our understanding of the causes, optimal investigation, and management of syncope through publication of practice guidelines in 2001, 2004, and 2009.1–3 The 2009 ESC guidelines recommend the establishment of formal Syncope Units (SUs)—either virtual or physical site within a hospital or clinic facility—with access to syncope specialists and specialized equipment.3 In response, this position statement by the European Heart Rhythm Association (EHRA) endorsed by the Heart Rhythm Society (HRS) offers a pragmatic approach to the rationale and requirement for an SU, based on specialist consensus, existing practice and scientific evidence (see Appendix). The panel consists of specialists who have experience in developing and leading such units representing cardiology, geriatric and general internal medicine, neurology, and emergency medicine. This document is addressed to physicians and others in administration, who are interested in establishing an SU in their hospital, so that they can meet the standards proposed by ESC-EHRA-HRS.1–3 ### Definition of syncope and transient loss of consciousness Syncope is a transient loss of consciousness (T-LOC) due to transient global cerebral hypoperfusion, and is characterized by rapid onset, short duration, and spontaneous complete recovery. This definition of syncope has been developed by the Task Force for the Diagnosis and Management of Syncope of the ESC and endorsed by the EHRA, European Heart Failure Association and European Heart Rhythm Society. Transient loss of consciousness is a term that encompasses all disorders characterized by self-limited LOC, irrespective of mechanism.1–3 By including the mechanism of unconsciousness, i.e. transient global cerebral hypoperfusion, the current syncope definition excludes other causes of T-LOC such as epileptic seizures and concussion, as well as certain common syncope mimics, such as psychogenic pseudosyncope. ### Definition of a Syncope Unit An SU is a facility featuring a standardized approach to the diagnosis and management …