The Scoop on the New Syncope Guidelines

Mayo Clinic electrophysiologist,Win Shen, M.D., discusses the recently released American College of Cardiology/American Heart Association (ACC/AHA) Syncope Guidelines. Visit for more information or to schedule an appointment. Approximately 40% of the US population has syncope, and it can be associated with many conditions. The goal of the ACC/AHA syncope guidelines is to provide a comprehensive recommendation for this very diverse patient population. This included setting a standard definition for syncope, setting a standard practice, and identifying the areas where additional data is needed. One of the challenges with syncope is determining what testing should be performed. The ACC/AHA syncope guideline committee determined that a detailed history and exam as well as an ECG is necessary; however, there are several class III recommendations including imaging and broad blood testing that should be included in select patient populations. The ACC/AHA syncope guideline committee has also developed a list of serious medical conditions to determine the need for hospital admission. Driving after syncope can be difficult for physicians to address. It was determined by the committee 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. Regarding private driving, the committee has created a summary table with suggestions. Video Content Outline: • Introduction • History (0:44) • Goals of syncope guidelines (2:00) o Set a standard definition for syncope (2:06) o Recommend and set a standard practice (2:34) o Identify area where additional data is needed (2:55) • Making a diagnosis (3:10) o How much testing is sufficient (3:24) o What testing is not recommended (4:29) • In the ED: To admit or not to admit (5:43) o Summary table with serious medical conditions information (5:50) • Electrophysiology and Tilt-Table Testing in Select Patients (6:36) o Value of EP studies (6:47) o Tilt-Table Testing (7:57) • Management of Recurrent Vasovagal Syncope (8:41) o Recommendations for management of vasovagal syncope (9:05) o Should syncope patients receive a pacemaker (10:00) o What qualifies as a significant pause for pacemaker implantation (11:22) • Driving After Syncope (12:05) o Commercial Driving – DOT recommendation decides (13:08) o Private Driving (13:35) • Conclusion (14:09)