REVIEW – June 2010

New version of guidelines for diagnosing and management of syncope 2009


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A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organizations. The first ESC Guidelines for management of syncope were published in 2001, and reviewed in 2004. In March 2008, the CPG considered that there were enough new data to justify the production of new guidelines. There are two main aspects of this document that differentiate it from its predecessors. The first is stressing the concept that there are two distinct reasons for evaluating patients with syncope: one is to identify the precise cause in order to address an effective mechanism-specific treatment; the other is identification of the specific risk for the patient which frequently depends on the underlying disease rather than on the mechanism of syncope itself.

The second aspect is production of a comprehensive document which is addressed not only to cardiologists but also to all physicians who are interested in the field. The document was developed in collaboration with the European Heart Rhythm Association (EHRA), the Heart Failure Association (HFA), and the Heart Rhythm Society (HRS). It was endorsed by the following societies: the European Society  of Emergency Medicine (EuSEM), the European Federation of Internal Medicine (EFIM), the European Union Geriatric Medicine Society (EUGMS), the American Geriatrics Society (AGS), the European Neurological Society (ENS), the European Federation of Autonomic Societies (EFAS), and the American Autonomic Society (AAS).

The content includes the definition, classification and pathophysiology, and impact on quality of life and economic issues. An important part of management of patients is initial evaluation, diagnosis, and risk stratification. Reflex syncope is the most frequent cause of syncope in any setting. Syncope secondary to cardiovascular disease is the second most common cause. Non-syncopal conditions, misdiagnosed as syncope at initial evaluation, are more frequent in emergency referrals and reflect the multifactorial complexity of these patients. The high unexplained syncope rate in all settings justifi es new strategies for evaluation and diagnosis. The recommendat ions for formulating and issuing ESC guidel ines and expert consensus documents and guidelines can be found on the ESC Web Site (

The document was published in the European Heart Journal 2009;30:2631–71.