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ACC/AHA 2017 Syncope

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope

The first US guideline dedicated to syncope, published a year before the ESC's. Its most useful contribution is negative: in a patient with syncope and no focal neurological findings, routine head CT or MRI, carotid ultrasound and EEG are Class 3 (no benefit) — testing that is still ordered in a large minority of patients. Everything else follows a structured history, examination and ECG, with risk stratification driving disposition from the emergency department. On treatment the two societies broadly agree — physical counterpressure manoeuvres first, drugs only for a heavy symptom burden, and pacing reserved for documented spontaneous asystole in older patients with recurrent reflex syncope. The register's trials are grouped below.

This guideline cites 4 of the 199 landmark trials in our Cardiology register.

Source
Shen WK, Sheldon RS, et al. Circulation. 2017;136(5):e60–e122.
Read the full guideline ↗

Pharmacotherapy of reflex syncope2

  • 2016POST-2Cardiology · Arrhythmia · Vasovagal syncopePrevention of Syncope Trial 2
  • 2006POSTCardiology · Arrhythmia · Vasovagal syncopePrevention of Syncope Trial

Pacing — only for documented asystole2

  • 2012ISSUE-3Cardiology · Arrhythmia · Pacing for reflex syncopeThird International Study on Syncope of Uncertain Etiology
  • 2003VPS-IICardiology · Arrhythmia · Pacing for reflex syncopeSecond Vasovagal Pacemaker Study

Published since the guideline2

  • 2021POST-4Cardiology · Arrhythmia · Vasovagal syncopePrevention of Syncope Trial 4
  • 2021BIOSync CLSCardiology · Arrhythmia · Pacing for reflex syncopeCardiac pacing in severe recurrent reflex syncope and tilt-induced asystole