Francisco Pascual J, Jordan Marchite P, Rodríguez Silva J, Rivas Gándara N. Arrhythmic syncope: From diagnosis to management. World J Cardiol 2023; 15(4): 119-141 [PMID: 37124975 DOI: 10.4330/wjc.v15.i4.119]
Corresponding Author of This Article
Jaume Francisco Pascual, FESC, MD, MSc, Staff Physician, Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Passeig de la Vall Hebron 119-129, Barcelona 08035, Spain. jaume.francisco@vallhebron.cat
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Apr 26, 2023; 15(4): 119-141 Published online Apr 26, 2023. doi: 10.4330/wjc.v15.i4.119
Arrhythmic syncope: From diagnosis to management
Jaume Francisco Pascual, Pablo Jordan Marchite, Jesús Rodríguez Silva, Nuria Rivas Gándara
Jaume Francisco Pascual, Pablo Jordan Marchite, Jesús Rodríguez Silva, Nuria Rivas Gándara, Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
Jaume Francisco Pascual, Grup de Recerca Cardiovascular, Vall d’Hebron Institut de Recerca, Barcelona 08035, Spain
Jaume Francisco Pascual, Nuria Rivas Gándara, CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
Jaume Francisco Pascual, Nuria Rivas Gándara, Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
Author contributions: Francisco Pascual J prepared the concept and design and drafted and edited the manuscript; Jordan Marchite P and Rodríguez Silva J contributed to collecting data, creating the tables and figures, and writing part of the manuscript; and all other authors contributed to design and reviewed the manuscript and approved the content of the final version of the manuscript.
Conflict-of-interest statement: The Arrhythmia Unit receives fellowship grants from Boston Scientific and research grants from Abbott. Francisco Pascual J receives advisory and speaking honoraria from Abbott and Microport. Rivas Gándara N receives advisory and speaking honoraria from Abbott. The other authors report no conflicts.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jaume Francisco Pascual, FESC, MD, MSc, Staff Physician, Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Passeig de la Vall Hebron 119-129, Barcelona 08035, Spain. jaume.francisco@vallhebron.cat
Received: January 6, 2023 Peer-review started: January 6, 2023 First decision: January 20, 2023 Revised: February 2, 2023 Accepted: April 10, 2023 Article in press: April 10, 2023 Published online: April 26, 2023 Processing time: 103 Days and 22.9 Hours
Abstract
Syncope is a concerning symptom that affects a large proportion of patients. It can be related to a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death. However, benign causes are the most frequent, and identifying high-risk patients with potentially severe etiologies is crucial to establish an accurate diagnosis, initiate effective therapy, and alter the prognosis. The term cardiac syncope refers to those episodes where the cause of the cerebral hypoperfusion is directly related to a cardiac disorder, while arrhythmic syncope is cardiac syncope specifically due to rhythm disorders. Indeed, arrhythmias are the most common cause of cardiac syncope. Both bradyarrhythmia and tachyarrhythmia can cause a sudden decrease in cardiac output and produce syncope. In this review, we summarized the main guidelines in the management of patients with syncope of presumed arrhythmic origin. Therefore, we presented a thorough approach to syncope work-up through different tests depending on the clinical characteristics of the patients, risk stratification, and the management of syncope in different scenarios such as structural heart disease and channelopathies.
Core Tip: In this review, we summarized the most important and novel data on arrhythmic syncope, the value of the different diagnostic tests, the management, and the specific characteristics in some particular populations such as patients with cardiomyopathies or channelopathies. The review emphasized the importance of an appropriate stepwise approach work-up and intervention.
