Bradycardias and Tachycardias: Acquired and Inheritable

Abstract

The majority of episodes of syncope are innocent and will not occur again. However, in certain instances, in particular when associated with brady- or tachyarrhythmias, syncope is more likely to be recurrent or predict risk of sudden death. A comprehensive evaluation including patient history, physical examination, and directed investigations allows the clinician to discriminate between innocent and sinister syncope. Arrhythmic syncope is typically associated with minimal prodrome or postdrome, and a higher risk of injury. Identification of the key presenting features is the first step in risk stratification and directs the clinician to an optimal investigation strategy and, as such, timely diagnosis and treatment.

This chapter describes the features that characterize arrhythmic syncope, and the recognition and management of the culprit arrhythmia. This will include a focus on the initial evaluation of the syncopal patient that distinguishes primary tachy- and bradyarrhythmias from the other forms of syncope and pseudosyncope. An approach to interpretation of symptomatic and asymptomatic arrhythmias is outlined. Appropriate diagnostic testing including the approach to various forms of cardiac monitoring leads to a diagnosis, which is typically associated with definitive therapy, ranging from medical and device therapy to catheter ablation.