title: Overview of the contribution of recent clinical trials to advancement of syncope management.
abstract: In this communication we review those trials that have contributed in recent years to improving our knowledge on the management (diagnosis and treatment) of syncope. In this regard, most recent trials focus on vasovagal syncope (VVS) and consequently these will be the focus of this manuscript. In essence, from a diagnostic perspective the ISSUE studies demonstrate the value of insertable loop recorders (ILR), while in terms of treatment, in the case of VVS current data strongly support use of non-pharmacologic treatment as a primary approach. There is no clear evidence supporting pharmacologic treatment with the possible exception of midodrine. Further, the most recent ISSUE trials suggest that in older very symptomatic patients with VVS in whom an asystole has been documented during spontaneous episode or possibly after ATP administration, implantation of a permanent pacemaker (PPM) can be effective. Which pacing or programming mode will be the more beneficial has not been completely clarified. Management of other forms of neurally-mediated syncope (e.g., carotid sinus syndrome) or other causes of syncope has not been addressed by clinical trials. In those cases, direction is provided by older evidence, the vast majority of which is based on observational reports or small non-randomized patient series.
authors.affiliation: Unitat d'Arítmies, Cardiology Department, University Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, 08035 Barcelona, Spain. amoya@vhebron.net
authors.forename: Angel
authors.initials: A
authors.lastname: Moya
authors.forename: Nuria
authors.initials: N
authors.lastname: Rivas
authors.forename: Jordi
authors.initials: J
authors.lastname: Perez-Rodon
mesh_terms: D002304:Cardiac Pacing, Artificial; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004867:Equipment Design; D019317:Evidence-Based Medicine; D005440:Fluid Therapy; D006327:Heart Block / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D009119:Muscle Contraction; D010138:Pacemaker, Artificial; D026741:Physical Therapy Modalities; D011187:Posture; D011237:Predictive Value of Tests; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D019462:Syncope, Vasovagal / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents