Abstract
Syncope of cardiac origin may be associated with an increased risk of sudden cardiac death if not treated in a timely and appropriate manner. The diagnostic approach of syncope imposes a significant economic burden on society. The investigation and elucidation of the pathogenetic mechanism of syncope are of great clinical importance, as both prognosis and appropriate therapeutic approaches depend on these factors. The responsible mechanism of presyncope or syncope can only be revealed through the patient history, baseline clinical examination and electrocardiogram. The percentage of patients who are diagnosed with these tests alone exceeds 50%. In patients with a history of organic or acquired heart disease or/and the presence of abnormal findings on the electrocardiogram, a further diagnostic electrophysiology inclusive approach should be followed to exclude life threatening arrhythmiological mechanism. However, if the patient does not suffer from underlying heart disease and does not show abnormal electrocardiographic findings in the electrocardiogram, then the probability in the electrophysiology study to find a responsible cause is small but not absent. The role of a two-step electrophysiology study inclusive risk stratification approach for the effective management of the former is thoroughly discussed in this review.
Highlights
Syncope is a clinical syndrome defined as the transient loss of consciousness, associated with the inability to maintain postural tone and accompanied by a fall to the ground, with rapid and spontaneous recovery
Healthcare expenditure is essential since syncope is an ordinary symptom with a variety of underlying causes leading to patient visits to physicians, the emergency department, and to hospitalizations after syncope [7]
The official guideline recommendations for permanent pacing are based on observational studies [56,57,58] and not on randomized clinical studies, and the evidence of electrophysiology study (EPS) to assess atrioventricular node conduction disease or/and sinus node disease in patients with syncope depends only on the baseline H-V interval, second- or third-degree His-Purkinje block during incremental atrial pacing or with pharmacological challenge and prolongation of the corrected sinus node recovery time [2,59]
Summary
Syncope is a clinical syndrome defined as the transient loss of consciousness, associated with the inability to maintain postural tone and accompanied by a fall to the ground, with rapid and spontaneous recovery. It is caused by a period of inadequate cerebral nutrient flow, most often the result of various factors causing an abrupt drop of systemic blood pressure. Presyncope is the prodromal phase of syncope, characterized by dizziness, lightheadedness, weakness, nausea, with transient alteration of consciousness, without complete loss, and without necessarily falling on the ground [2]. Hearts 2021, 2 electrophysiology study inclusive risk stratification approach for the effective management of the former is thoroughly discussed in this review
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