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ESC 2018 Syncope

2018 ESC Guidelines for the diagnosis and management of syncope

The 2018 ESC syncope guideline is built around one idea: treat the mechanism, not the diagnosis. Pacing helps in reflex syncope only when asystole has actually been documented — a lesson learned the hard way from the unblinded early pacemaker trials — and drug therapy is reserved for young patients with a heavy symptom burden. The register's trials are grouped by that logic below.

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

Source
Brignole M, Moya A, et al. Eur Heart J. 2018;39(21):1883–1948. · European Heart Journal
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 when asystole is documented2

  • 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