Win-Kuang Shen, M.D., electrophysiologist and Cardiology chair at Mayo Clinic's campus in Phoenix/Scottsdale, Arizona, discusses the recently released 2017 American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) Guideline for the Evaluation and Management of Patients With Syncope.

Approximately 40 percent of the U.S. population has syncope, which can be associated with many conditions. The goal of the ACC/AHA/HRS syncope guidelines is to provide a comprehensive recommendation for this very diverse patient population, including:

• Setting a standard definition for syncope

• Setting a standard practice

• Identifying the areas where additional data is needed

What testing should be performed?

The Syncope Guideline committee determined that a detailed history and exam, as well as an electrocardiogram, is necessary. However, there are several class III recommendations, including imaging and broad blood testing, that should be included in select patient populations.

The committee also developed a list of serious medical conditions to determine the need for hospital admission.

Driving after syncope

The committee determined that physicians should be familiar with local and federal laws regarding driving after syncope. The Department of Transportation has strict rules regarding commercial driving, so the committee deferred to the federal laws concerning driving after syncope. The committee also created a summary table with suggestions related to private driving.

View video transcript

Video content outline:

• Introduction

• History (0:44)

• Goals of syncope guidelines (2:00)

  • Set a standard definition for syncope (2:06)

  • Recommend and set a standard practice (2:34)

  • Identify area where additional data is needed (2:55)

• Making a diagnosis (3:10)

  • How much testing is sufficient (3:24)

  • What testing is not recommended (4:29)

• In the ED: To admit or not to admit (5:43)

  • Summary table with serious medical conditions information (5:50)

• Electrophysiology and tilt table testing in select patients (6:36)

  • Value of EP studies (6:47)

  • Tilt table testing (7:57)

• Management of recurrent vasovagal syncope (8:41)

  • Recommendations for management of vasovagal syncope (9:05)

  • Should syncope patients receive a pacemaker (10:00)

  • What qualifies as a significant pause for pacemaker implantation (11:22)

• Driving after syncope (12:05)

  • Commercial driving — DOT recommendation decides (13:08)

  • Private driving (13:35)

• Conclusion (14:09)

Read the report

Shen WK et al. 2017 American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) Guideline for the Evaluation and Management of Patients With Syncope. Journal of the American College of Cardiology. In press.