[How is syncope studied in the Italian hospitals?].
BACKGROUND
The aim of this study was to evaluate how the main tests for the diagnostic assessment of syncope are currently performed in the Italian hospitals.


METHODS
During the early 2003 dedicated questionnaires were administered to about 400 Italian hospitals. About each test information was requested relative to: test protocol, laboratory equipment, patients evaluated during 2002.


RESULTS
Eighty-four hospitals answered the questionnaire. A syncope-dedicated ambulatory (at least once a week) was available during 2002 in 59/84 hospitals, and 56 were dependent on the Cardiology Division. Carotid sinus massage was performed either in clinostatic and in orthostatic position in 60 Centers and was repeated after atropine in 15. To define the test positivity, 35 Centers followed the "symptom method". Only 15 Centers performed > 100 procedures during 2002 (range 3-500). Tilt testing was performed in 72 hospitals. A dedicated tilting bed was available in 65 Centers, continuous beat-to-beat pressure measurement in 22. Out of the 72 Centers, 55 followed the so-called "Italian protocol" as the main methodology of the test. Only 17 Centers performed > 100 procedures during 2002 (range 3-500). Adenosine test was performed in 26 hospitals, the median dose of drug was 18 mg (range 6-20 mg); 25 out 26 Centers considered the test as positive when an asystolic pause > or = 6 s was observed. Only 6 Centers performed > 15 procedures during 2002 (range 1-204). An implantable loop recorder was available in 48 Centers. The number of implant procedures during 2002 varied among the Centers from 1 to 22.


CONCLUSIONS
A great variability was observed concerning the methodology of each test and the number of procedures performed. Thus, a standardization effort about the methodology of syncope study is still needed by the medical associations.
Bartoletti
Angelo
A
Task Force Associazione Italiana di Aritmologia e Cardiostimolazione, Modello organizzativo di Syncope Unit. angelobartoletti@libero.it
Brignole
Michele
M
Proclemer
Alessandro
A
Alboni
Paolo
P
Ammirati
Fabrizio
F
Del Rosso
Attilio
A
Del Greco
Maurizio
M
Disertori
Marcello
M
Manzillo
Giovanni Foglia
GF
Giada
Franco
F
Menozzi
Carlo
C
Raviele
Antonio
A
D000241:Adenosine / Q000008:administration & dosage; D000328:Adult; D001794:Blood Pressure; D002346:Carotid Sinus / Q000502:physiology; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D006323:Heart Arrest; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007558:Italy; D008405:Massage; D008875:Middle Aged; D011187:Posture; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D013575:Syncope / Q000175:diagnosis* / Q000503:physiopathology; D018667:Tilt-Table Test; D013997:Time Factors; D014665:Vasodilator Agents / Q000008:administration & dosage
D014665:Vasodilator Agents; D000241:Adenosine