Syncope pp 199-224 | Cite as

Cardiac Syncope

  • Michele Brignole
  • David G. Benditt


“Cardiac syncope” comprises those causes of syncope that are primarily due to disturbances of cardiac or cardiovascular function.1 Thus, cardiac conduction system disease, primary cardiac rhythm disturbances, and cardiovascular structural abnormalities are incorporated within this category (previously “cardiac arrhythmias” and “structural cardiac and cardiovascular disease” were considered as separate classes2,3).


Structural Heart Disease Right Ventricular Outflow Tract Brugada Syndrome Right Bundle Branch Block Sinus Node Dysfunction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Moya A, et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J. 2009;30:2631–2671.PubMedCrossRefGoogle Scholar
  2. 2.
    Brignole M, et al. Guidelines on management (diagnosis and treatment) of syncope. Europace. 2004;6:467–537.PubMedCrossRefGoogle Scholar
  3. 3.
    Jhanjee R, et al. Syncope. Mosby: Disease-a-Month; 2009:527–586.Google Scholar
  4. 4.
    Soteriades ES, et al. Incidence and prognosis of syncope. N Engl J Med. 2002;347:878–885.PubMedCrossRefGoogle Scholar
  5. 5.
    Savage DD, et al. Epidemiologic features of isolated syncope: The Framingham Study. Stroke. 1985;16:626–629.PubMedCrossRefGoogle Scholar
  6. 6.
    Pires LA, et al. Comparison of event rates and survival in patients with unexplained syncope without documented ventricular tachyarrhythmias versus patients with documented sustained ventricular tachyarrhythmias both treated with implantable cardioverter-defibrillators. Am J Cardiol. 2000;85:725–728.PubMedCrossRefGoogle Scholar
  7. 7.
    Olshansky B, et al. Clinical significance of syncope in the electrophysiologic study versus electrocardiographic monitoring (ESVEM) trial. The ESVEM Investigators. Am Heart J. 1999;137:878–886.PubMedCrossRefGoogle Scholar
  8. 8.
    Steinberg JS, et al. Follow-up of patients with unexplained syncope and inducible ventricular tachyarrhythmias: analysis of the AVID registry and an AVID substudy. Antiarrhythmics versus implantable defibrillators. J Cardiovasc Electrophysiol. 2001;12:996–1001.PubMedCrossRefGoogle Scholar
  9. 9.
    Knight BP, et al. Outcome of patients with nonischemic dilated cardiomyopathy and unexplained syncope treated with an implantable defibrillator. J Am Coll Cardiol. 1999;33: 1964–1970.PubMedCrossRefGoogle Scholar
  10. 10.
    Olshansky B, et al. Syncope predicts the outcome of cardiomyopathy patients: Analysis of the SCD-HeFT study. J Am Coll Cardiol. 2008;51:1277–1282.PubMedCrossRefGoogle Scholar
  11. 11.
    Sauer A, et al. Long QT Syndrome in Adults. J Am Coll Cardiol. 2007;49:329–337.PubMedCrossRefGoogle Scholar
  12. 12.
    Sacher F, et al. Outcome after implantation of a cardioverter-defibrillator in patients with Brugada syndrome. A Multicenter Study. Circulation. 2006;114:2317–2324.PubMedCrossRefGoogle Scholar
  13. 13.
    Sarkozy A, et al. Long-term follow-up of primary prophylactic implantable cardioverter-defibrillator therapy in Brugada syndrome. Eur Heart J. 2007;28:334–344.PubMedCrossRefGoogle Scholar
  14. 14.
    Paparella G, et al. Brugada syndrome: The prognostic dilemma and value of syncope. Minerva Med. 2009;100:307–319.PubMedGoogle Scholar
  15. 15.
    Paul M, et al. Role of programmed ventricular stimulation in patients with Brugada syndrome: A meta-analysis of worldwide published data. Eur Heart J. 2007;28:2126–2133.PubMedCrossRefGoogle Scholar
  16. 16.
    Alboni P, et al. The diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Cardiol. 2001;37:1921–1928.PubMedCrossRefGoogle Scholar
  17. 17.
    Del Rosso A, et al. Relation of clinical presentation of syncope to the age of patients. Am J Cardiol. 2005;96:1431–1435.PubMedCrossRefGoogle Scholar
  18. 18.
    Del Rosso A, et al. Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score. Heart. 2008;94:1620–1626.PubMedCrossRefGoogle Scholar
  19. 19.
    Colivicchi F, et al. Epidemiology and prognostic implications of syncope in young competing athletes. Eur Heart J. 2004;25:1749–1753.PubMedCrossRefGoogle Scholar
  20. 20.
    Benditt DG, et al. Sinus node dysfunction. In: Willerson JT, Cohn JN, eds. Cardiovascular Medicine. 3rd edn. Edinburgh: Churchill Livingstone; 2006:1925–1935.Google Scholar
  21. 21.
    Benditt DG, et al. Indications for electrophysiologic testing in the diagnosis and assessment of sinus node dysfunction. Circulation. 1987;75(Suppl III):93–99.Google Scholar
  22. 22.
    Raj S. Highlights in clinical autonomic neurosciences. Orthostatic tachycardia and orthostatic hypotension. Autonom Neurosci Basic and Clin. 2010;154:1–2.Google Scholar
  23. 23.
    Gann D, et al. Electrophysiologic evaluation of elderly patients with sinus bradycardia: a long-term follow-up study. Ann Intern Med. 1979;90:24–29.PubMedGoogle Scholar
  24. 24.
    Fragakis N, et al. The value of adenosine test in the diagnosis of sick sinus syndrome: susceptibility of sinus and atrioventricular node to adenosine in patients with sick sinus syndrome and unexplained syncope. Europace. 2007;9:559–562.PubMedCrossRefGoogle Scholar
  25. 25.
    Flammang D, et al. The adenosine triphosphate (ATP) test for evaluation of syncope of unknown origin. J Cardiovasc Electrophysiol. 2005;16:1388–1389.PubMedCrossRefGoogle Scholar
  26. 26.
    Perennes A, et al. Epidemiology, clinical features, and follow-up of patients with syncope and a positive adenosine triphosphate test result. J Am Coll Cardiol. 2006;47:594–597.PubMedCrossRefGoogle Scholar
  27. 27.
    Brignole M, et al. Lack of correlation between the responses to tilt testing and adenosine triphosphate test and the mechanism of spontaneous neurally mediated syncope. Eur Heart J. 2006;27:2232–2239.PubMedCrossRefGoogle Scholar
  28. 28.
    Menozzi C, et al. Mechanism of syncope in patients with heart disease and negative electrophysiologic test. Circulation. 2002;105:2741–2745.PubMedCrossRefGoogle Scholar
  29. 29.
    Brignole M, et al. Investigators. Mechanism of syncope in patients with bundle branch block and negative electrophysiological test. Circulation. 2001;104:2045–2050.PubMedCrossRefGoogle Scholar
  30. 30.
    Brignole M, et al. Indications for the use of diagnostic implantable and external ECG loop recorders. Task Force members. Europace. 2009;11:671–687.PubMedCrossRefGoogle Scholar
  31. 31.
    Brignole M, et al. Improved arrhythmia detection in implantable loop recorders. J Cardiovasc Electrophysiol. 2008;19:928–934.PubMedCrossRefGoogle Scholar
  32. 32.
    Villain E. Indications for pacing in patients with congenital heart disease. Pacing Clin Electrophysiol. 2008;31(Suppl 1):S17–S20.PubMedCrossRefGoogle Scholar
  33. 33.
    Michaelsson M, et al. A natural history of congenital atrio-ventricular block. Pacing Clin Electrophysiol. 1997;20:2098–2101.PubMedCrossRefGoogle Scholar
  34. 34.
    Camm AJ, Lau CP. Syncope of undetermined origin: diagnosis and management. Prog Cardiol. 1988;1:139–156.Google Scholar
  35. 35.
    Maron BJ, et al. Contemporary definitions and classification of the cardiomyopathies. Circulation. 2006;113:1807–1816.PubMedCrossRefGoogle Scholar
  36. 36.
    Corrado D, et al. Implantable cardioverter-defibrillator therapy for prevention of sudden death in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circulation. 2003;108:3084–3091.PubMedCrossRefGoogle Scholar
  37. 37.
    Maron BJ, et al. Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation. 2004;109:2807–2816.PubMedCrossRefGoogle Scholar
  38. 38.
    Marcus FI, et al. Arrhythmogenic right ventricular cardiomyopathy/dysplasia clinical presentation and diagnostic evaluation: results from the North American Multidisciplinary Study. Heart Rhythm. 2009;6:984–992.PubMedCrossRefGoogle Scholar
  39. 39.
    Farzaneh-Far A, Lerman BB. Idiopathic ventricular outflow tract tachycardia. Heart. 2005;91:136–138.PubMedCrossRefGoogle Scholar
  40. 40.
    Chun KR, et al. Left ventricular outflow tract tachycardia including ventricular tachycardia from the aortic cusps and epicardial ventricular tachycardia. Herz. 2007;32:226–232.PubMedCrossRefGoogle Scholar
  41. 41.
    Jackman WM, et al. The long QT syndromes: a critical review, new clinical observations and a unifying hypothesis. Prog Cardiovasc Dis. 1988;31:115–172.PubMedCrossRefGoogle Scholar
  42. 42.
    Moss AJ, et al. The long QT syndrome: prospective longitudinal study of 328 families. Circulation. 1991;84:1136–1144.PubMedCrossRefGoogle Scholar
  43. 43.
    Schwartz PJ, et al. Stress and sudden death: the case of the long QT syndrome. Circulation. 1991;83(Suppl II):71–80.Google Scholar
  44. 44.
    Moss AJ, et al. ECG T-wave patterns in genetically distinct forms of the hereditary long QT syndrome. Circulation. 1995;92:2929–2934.PubMedCrossRefGoogle Scholar
  45. 45.
    Zareba W, Cygankiewicz I. Long QT syndrome and short QT syndrome. Prog Cardiovasc Dis. 2008;51:264–278.PubMedCrossRefGoogle Scholar
  46. 46.
    Johnson JN, Ackerman MJ. QTc: How long is too long? Br J Sports Med. 2009;43:657–662.PubMedCrossRefGoogle Scholar
  47. 47.
    Colman N, et al. Value of history-taking in syncope patients: In whom to suspect long QT syndrome?. Europace. 2009;11:937–943.PubMedCrossRefGoogle Scholar
  48. 48.
    Antzelevitch C, et al. Brugada syndrome: report of the second consensus conference. Circulation. 2005;111:659–670.PubMedCrossRefGoogle Scholar
  49. 49.
    Spirito P, et al. Implantable cardioverter defibrillators and prevention of sudden death in hypertrophic cardiomyopathy. J Am Med Assoc. 2007;298:405–412.CrossRefGoogle Scholar
  50. 50.
    Spirito P, et al. Syncope and risk of sudden death in hypertrophic cardiomyopathy. Circulation. 2009;119:1703–1710.PubMedCrossRefGoogle Scholar
  51. 51.
    Nallamothu BK, et al. Syncope in acute aortic dissection: Diagnostic, prognostic and clinical implications. Am J Med. 2002;113:468–471.PubMedCrossRefGoogle Scholar
  52. 52.
    Krahn AD, et al. Randomized assessment of syncope trial: conventional diagnostic testing versus a prolonged monitoring strategy. Circulation. 2001;104:46–51.PubMedCrossRefGoogle Scholar
  53. 53.
    Krahn AD, et al. Cost implications of testing strategy in patients with syncope. Randomized assessment of syncope trial. J Am Coll Cardiol. 2003;42:495–501.PubMedCrossRefGoogle Scholar
  54. 54.
    Brignole M, et al. Early application of an implantable loop recorder allows a mechanism-based effective therapy in patients with recurrent suspected neurally-mediated syncope. Eur Heart J. 2006;27:1085–1092.PubMedCrossRefGoogle Scholar
  55. 55.
    Morady F, et al. Long-term follow-up of patients with recurrent unexplained syncope evaluated by electrophysiologic testing. J Am Coll Cardiol. 1983;2:1053–1059.PubMedCrossRefGoogle Scholar
  56. 56.
    Sra JS, et al. Unexplained syncope evaluated by electrophysiologic studies and head-up tilt testing. Ann Intern Med. 1991;114:1013–1019.PubMedGoogle Scholar
  57. 57.
    Fujimura O, et al. The diagnostic sensitivity of electrophysiologic testing in patients with syncope caused by bradycardia. N Engl J Med. 1989;321:1703–1707.PubMedCrossRefGoogle Scholar
  58. 58.
    Brembilla-Perrot B, et al. Are the results of electrophysiological study different in patients with a pre-excitation syndrome, with and without syncope? Europace. 2008;10:175–180.PubMedCrossRefGoogle Scholar
  59. 59.
    Brembilla-Perrot B, et al. Increased sensitivity of electrophysiological study by isoproterenol infusion in unexplained syncope. Int J Cardiol. 2006;106:82–87.PubMedCrossRefGoogle Scholar
  60. 60.
    Chen LY, et al. Score indices for predicting electrophysiologic outcomes in patients with unexplained syncope. J Interv Card Electrophysiol. 2005 Nov;14:99–105.PubMedCrossRefGoogle Scholar
  61. 61.
    Brilakis ES, et al. Programmed ventricular stimulation in patients with idiopathic dilated cardiomyopathy and syncope receiving implantable cardioverter-defibrillators: A case series and a systematic review of the literature. Int J Cardiol. 2005;98:395–401.PubMedCrossRefGoogle Scholar
  62. 62.
    Fitzpatrick A, et al. The incidence of malignant vasovagal syndrome in patients with recurrent syncope. Eur Heart J. 1991;12:389–394.PubMedGoogle Scholar
  63. 63.
    McDermott D, et al. Acute myocardial infarction in patients with syncope. Can J Emerg Med. 2009;11:156–160.Google Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  1. 1.Dipartimento di Cardiologia, Centro AritmologicoOspedali del TigullioLavagnaItaly
  2. 2.Cardiac Arrhythmia CenterMedical School, University of MinnesotaMinneapolisUSA

Personalised recommendations