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Are bradyarrhythmias always the main cause of syncope in the elderly?

Published:October 13, 2022DOI:https://doi.org/10.1016/j.hrthm.2022.10.008
      Managing patients with syncope is a major challenge for most cardiologists.
      • Shen W.K.
      • Sheldon R.S.
      • Benditt D.G.
      • et al.
      2017 ACC/AHA/HRS Guideline for the evaluation and management of patients with syncope: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
      This is mainly due to complexity and number of mechanisms that may cause or be associated with syncopal episodes. Whereas in young subjects syncope is often considered benign and a conservative approach is generally appropriate, its management becomes more complex and controversial in the elderly when a cardiac origin is documented or, often, suspected. In these patients, a syncopal episode may affect self-confidence in routine daily activities and increase concern for possible injuries related to falls and, in some cases, for death.
      • Shen W.K.
      • Sheldon R.S.
      • Benditt D.G.
      • et al.
      2017 ACC/AHA/HRS Guideline for the evaluation and management of patients with syncope: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
      ,
      • Brignole M.
      • Rivasi G.
      • Sutton R.
      • et al.
      Low-blood pressure phenotype underpins the tendency to reflex syncope.
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      References

        • Shen W.K.
        • Sheldon R.S.
        • Benditt D.G.
        • et al.
        2017 ACC/AHA/HRS Guideline for the evaluation and management of patients with syncope: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
        Circulation. 2017; 136: e25-e59
        • Brignole M.
        • Rivasi G.
        • Sutton R.
        • et al.
        Low-blood pressure phenotype underpins the tendency to reflex syncope.
        J Hypertens. 2021; 39: 1319-1325
        • Juraschek S.P.
        • Taylor A.A.
        • Wright Jr., J.T.
        • et al.
        Orthostatic hypotension, cardiovascular outcomes, and adverse events: results from SPRINT.
        Hypertension. 2020; 75: 660-667
        • Lubitz S.A.
        • Faranesh A.Z.
        • Atlas S.J.
        • et al.
        Rationale and design of a large population study to validate software for the assessment of atrial fibrillation from data acquired by a consumer tracker or smartwatch: the Fitbit heart study.
        Am Heart J. 2021; 238: 16-26
        • Neira V.
        • Enriquez A.
        • Sheldon R.
        • et al.
        Impact of bundle branch block morphology on outcomes of patients with syncope and bifas-cicular block: a SPRITELY (POST 3) substudy.
        Heart Rhythm. 2022;
        • Hofmeister M.
        • Sheldon R.S.
        • Spackman E.
        • et al.
        A cost-utility analysis of the Syncope: Pacing or Recording in the Later Years (SPRITELY) trial.
        CJC Open. 2022; 4: 617-624
        • Sutton R.
        • Fedorowski A.
        • Olshansky B.
        • et al.
        Tilt testing remains a valuable asset.
        Eur Heart J. 2021; 42: 1654-1660
        • Sheldon R.S.
        • Grubb B.P.
        • Olshansky B.
        • et al.
        2015 Heart Rhythm Society Expert Consensus Statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope.
        Heart Rhythm. 2015; 12: e41-e63
        • Roca-Luque I.
        • Francisco-Pascual J.
        • Oristrell G.
        • et al.
        Syncope, conduction disturbance, and negative electrophysiological test: predictive factors and risk score to predict pacemaker implantation during follow-up.
        Heart Rhythm. 2019; 16: 905-909
        • Antman E.M.
        • Loscalzo J.
        Precision medicine in cardiology.
        Nat Rev Cardiol. 2016; 13: 591-602

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