Syncope and Transient Loss of Consciousness Multidisciplinary Management

by Benditt, David G.; Brignole, Michele; Raviele, Antonio; Wieling, Wouter

• ISBN13: 9781405176255
• ISBN10: 1405176253
• Edition: 1st
• Format: Paperback
• Copyright: 2007-10-29
• Publisher: Wiley-Blackwell

Summary

The next step in developing guidelines for syncope managementTakes the next step toward developing multidisciplinary practice guidelines for managing the broad variety of conditions associated with transient loss of consciousness (TLOC), including syncope Expert contributors address specific aspects of the current ESC Guidelines to give clear evaluations of suggested changes Draws on published literature and the authors professional experience

Author Biography

David G Benditt, M.D., FACC, FRCP(C), FHRS

David G. Benditt, M.D. was born in Winnipeg, Canada. He received a B.Sc. degree in Electrical Engineering and an MD degree from the University of Manitoba. Following completion of postgraduate training in Internal Medicine, he moved to Duke University Medical Center in Durham, North Carolina where he completed a fellowship training in cardiology and cardiac electrophysiology. Thereafter, Dr Benditt joined the faculty of the Cardiovascular Division in the Dept of Medicine at the University of Minnesota where he established its training and research program in clinical cardiac electrophysiology

Dr. Benditt is currently Professor of Medicine and Co-director of the Cardiac Arrhythmia Center at the University of Minnesota in Minneapolis. He has been an Established Investigator of the American Heart Association, and President of both the American Heart Association-Minnesota Affiliate and the North American Society for Pacing and Electrophysiology (NASPE). Dr Benditt has recently been honored with the Pioneer in Pacing and Electrophysiology Award of the Heart Rhythm Society. He is a Fellow of both the American College of Cardiology, the Royal College of Physicians and Surgeons of Canada, and the Heart Rhythm Society (HRS). He is a member of the European Heart Rhythm Association (EHRA), and of the Council of Presidents of HRS. He is an associate editor of the Journal of Interventional Electrophysiology (JICE), and is a member of the Editorial Board of Europace. He has been a member of the Editorial Board of the Journal of the American College of Cardiology (JACC), The Journal of Cardiac Electrophysiology, and the American Journal of Cardiology (AJC). He has participated in many professional society Guidelines and Consensus reports, most recently the Syncope guidelines of the European Society of Cardiology. He is a medical consultant to the US Federal Aviation administration on evaluation of individuals with transient loss of consciousness, as well as to several medical device manufacturers. His principal research interests are directed toward the fields of autonomic control as it applies to syncope (fainting), and implantable and external devices for cardiac rhythm management.

Michele Brignole, MD FESC

From 1996, he is the chief of the Department of Cardiology of Ospedali del Tigullio, Lavagna, Italy.
He is Fellow of the European Society of Cardiology.
He was the chairman of the Task Force on Syncope of the European Society of Cardiology.
He is currently the President of AIAC, Associazione Italiana di Aritmologia e Cardiostimolazione.
The main research field has been diagnosis, pathophysiology and therapy of syncope and rhythm disturbances and radiofrequency catheter ablation of arrhythmias; he has published:
- 164 original papers currently quoted on Medline; he was first name in 75 of them.

Antonio Raviele, MD, FESC

Graduated with honors in Medicine and Surgery at Universita’ degli Studi di Napoli of University of Napoli in 1971
Specialized in Cardiology at Florence University in 1974
Since 1995 Chief of the Cardiology Division and since 2000 Chief of the Cardiovascular Department of the Umberto I Hospital of Venice-Mestre , Italy
From 2000 to 2004 President of AIAC, Italian Association of Arrhythmology and Cardiac Pacing; from 2004 to 2006 Past-President of the same Association
Founding Father and current General Secretary of ECAS, European Cardiac Arrhythmia Society
Fellow of the European Society of Cardiology and fellow of the Heart Ryhtm Society

W. Wieling. MD, PhD

Scientific and professional experience
1984- present. Head research group physiology and pathophysiology of the circulation of the Cardiovascular Research Institute of the AMC. This research group is a collaboration of clinicians, physiologists and engineers and its main interest is research on the short-term regulation of the circulation using non-invasive technologies.
1994- present associate professor Department of Internal Medicine, director syncope unit Academic Medical Centre
1999- 2004 member of the Executive Committtee of the European Society of
Cardiology Task Force on Syncope

Major areas of research interest
1. Autonomic nervous system control of the circulation in health and disease
2. Physiological strategies to improve orthostatic intolerance
3. Evaluation and treatment of syncope

Table of Contents

Contributors	p. ix
Preface	p. xiii
Syncope and TLOC overview
Definition and classification of syncope and transient loss of consciousness	p. 3
Epidemiologic aspects of transient loss of consciousness/syncope	p. 8
Pathophysiology of syncope: postural, neurally-mediated, and arrhythmic	p. 15
Cerebral perfusion in syncope	p. 20
Risk stratification-impact on diagnostic strategy	p. 24
Clinical evaluation strategies
Value and limitations of clinical history in assessing cause of syncope	p. 31
Emergency department evaluation of transient loss of consciousness/syncope	p. 36
The essential autonomic assessment for evaluating the cause of syncope	p. 39
Neurally-mediated reflex syncope: recognition by history and clinical testing	p. 44
Value and limitations of ambulatory electrocardiographic monitoring	p. 51
Recording ambulatory blood pressure in the syncope and TLOC evaluation	p. 56
Electrophysiologic testing: value and limitations in the transient loss of consciousness/syncope evaluation	p. 61
Intolerance to upright posture in autonomic failure and the postural tachycardia syndrome: assessment and treatment strategies	p. 67
Improving tolerance to upright posture: current status of tilt-training and other physical maneuvers	p. 72
Syncope in patients with bundle-branch block and other conduction system abnormalities	p. 76
Specific conditions
Treatment strategies in neurally-mediated reflex syncope: effectiveness of drugs, pacing, and physical maneuvers	p. 83
Structural heart disease, syncope, and risk of sudden death: selection of patients for implantable cardioverter-defibrillator therapy	p. 89
Channelopathies as a cause of syncope	p. 95
Distinguishing seizures and pseudosyncope from syncope	p. 102
Syncope and transient loss of consciousness in children and adolescents: congenital and acquired conditions	p. 111
Transient loss of consciousness, syncope, and falls in the elderly	p. 119
Drug-induced (iatrogenic) syncope	p. 129
Economic and research aspects
Syncope and the competitive athlete: recommendations for evaluation and permission to compete	p. 135
Role of syncope management units	p. 140
The impact of syncope and transient loss of consciousness on quality of life	p. 148
Current controversies and future directions
Driving and flying restrictions for the syncope and/or implanted cardiac device patient	p. 153
Clinical trials landscape: what's new, what's ongoing, what do we need	p. 157
Syncope and transient loss of consciousness: multidisciplinary management	p. 169
Syncope practice guidelines initiative	p. 176
syncope consortium members	p. 184
Index	p. 188
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