Do Symptoms Predict Cardiac Arrhythmias and Mortality in Patients With Syncope?

Abstract

Symptoms, although important in assigning many noncardiac causes, are not useful in risk-stratifying patients whose cause of syncope cannot be identified by other history and physical examination. Triage decisions and management plans should be based on pre-existing cardiac disease or electrocardiographic abnormalities, which are important predictors of arrhythmic syncope and mortality.

Guidelines on management (diagnosis and treatment) of syncope

“…In one study [41] , more than five lifetime episodes gave a 50% chance of recurrence in the following year. In another study [39] , age <45 years was also associated with higher rates of syncopal recurrence after controlling for other risk factors. After positive tilt table testing the patients with more than six syncopal spells had a risk of recurrence of >50% over 2 years [42] .…”

“…Predictors of recurrence of syncope include having had recurrent syncope at the time of presentation (four or more episodes in one study [38] ) or a psychiatric diagnosis [38][39][40] . In one study [41] , more than five lifetime episodes gave a 50% chance of recurrence in the following year.…”

Part 12: Education, Implementation, and Teams

“…In one LOE P3 study 481 a family history of syncope or SCD, palpitations as a symptom, supine syncope, and syncope associated with exercise and emotional stress were more common in patients with than without Long QT Syndrome (LQTS). Two LOE P5 studies in older adults 482,483 identified the absence of nausea and vomiting before syncope and electrocardiogram (ECG) abnormalities as independent predictors of arrhythmic syncope. Less than 5 seconds of warning signs before syncope and Ͻ2 syncope episodes were predictors of syncope due to ventricular tachycardia (VT) or atrioventricular (AV) block.…”

Permanent Cardiac Pacing Versus Medical Treatment for the Prevention of Recurrent Vasovagal Syncope

“…18 All patients were also questioned about the occurrence of trauma during syncopal spells. Syncoperelated traumatic injuries were classified as previously described 19 : major trauma (any fracture, head injury, or internal organ damage requiring hospital admission and surgical treatment) and minor trauma (any bruise, cut, and soft tissue injury).…”