title: Current investigation and management of patients with syncope: results of the European Heart Rhythm Association survey.
abstract: The aim of this European Heart Rhythm Association (EHRA) survey was to provide an insight into the current practice of work-up and management of patients with syncope among members of the EHRA electrophysiology research network. Responses were received from 43 centres. The majority of respondents (74%) had no specific syncope unit and only 42% used a standardized assessment protocol or algorithm. Hospitalization rates varied from 10% to 25% (56% of the centres) to >50% (21% of the centres). The leading reasons for hospitalization were features suggesting arrhythmogenic syncope (85% of respondents), injury (80%), structural heart disease (73%), significant comorbidities (54%), and older age (41%). Most widely applied tests were electrocardiogram (ECG), echocardiography, and Holter monitoring followed by carotid sinus massage and neurological evaluation. An exercise test, tilt table test, electrophysiological study, and implantation of a loop recorder were performed only if there was a specific indication. The use of a tilt table test varied widely: 44% of respondents almost always performed it when neurally mediated syncope was suspected, whereas 37% did not perform it when there was a strong evidence for neurally mediated syncope. Physical manoeuvres were the most widely (93%) applied standard treatment for this syncope form. The results of this survey suggest that there are significant differences in the management of patients with syncope across Europe, specifically with respect to hospitalization rates and indications for tilt table testing in neurally mediated syncope. The majority of centres reported using ECG, echocardiography, and Holter monitoring as their main diagnostic tools in patients with syncope, whereas a smaller proportion of centres applied specific assessment algorithms. Physical manoeuvres were almost uniformely reported as the standard treatment for neurally mediated syncope.
authors.affiliation: Second Cardiology Department, Attikon University Hospital, University of Athens, Rimini 1, 12462 Haidari Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Dagres
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Bongiorni
authors.forename: Dan
authors.initials: D
authors.lastname: Dobreanu
authors.forename: Antonio
authors.initials: A
authors.lastname: Madrid
authors.forename: Jesper Hastrup
authors.initials: JH
authors.lastname: Svendsen
authors.forename: Carina
authors.initials: C
authors.lastname: Blomström-Lundqvist
mesh_terms: D000465:Algorithms; D001118:Argentina; D019091:Critical Pathways / Q000639:trends*; D003935:Diagnostic Techniques, Cardiovascular / Q000639:trends*; D005060:Europe; D019983:Guideline Adherence / Q000639:trends; D019538:Health Care Surveys; D006757:Hospital Units / Q000639:trends; D006760:Hospitalization / Q000639:trends; D006785:Hospitals, University / Q000639:trends; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013575:Syncope / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D013997:Time Factors
keywords: EHRA survey; EP wire; Syncope; Syncope unit; Tilt test