Contemporary management of patients with syncope in clinical practice: An EHRA physician-based survey

Gheorghe Andrei Dan (Coresponding Author), Daniel Scherr, Kristīne Jubele, Michal M. Frakowski, Konstantinos Iliodromitis, Giulio Conte, Ewa Jȩdrzejczyk-Patej, Laura Vitali-Serdoz, Tatjana S. Potpara

Research output: Contribution to journalReview articlepeer-review

8 Citations (Scopus)


Syncope is a heterogeneous syndrome encompassing a large spectrum of mechanisms and outcomes. The European Society of Cardiology published an update of the Syncope Guidelines in 2018. The aim of the present survey was to capture contemporary management of syncope and guideline implementation among European physicians. A 23-item questionnaire was presented to 2588 European Heart Rhythm Association (EHRA) members from 32 European countries. The response rate was 48%, but only complete responses (n = 161) were included in this study. The questionnaire contained specific items regarding syncope facilities, diagnostic definitions, diagnostic tools, follow-up, and therapy. The survey revealed that many respondents did not have syncope units (88%) or dedicated management algorithms (44%) at their institutions, and 45% of the respondents reported syncope-related hospitalization rates >25%, whereas most (95%) employed close monitoring and hospitalization in syncope patients with structural heart disease. Carotid sinus massage, autonomic testing, and tilt-table testing were inconsistently used. Indications were heterogeneous for implanted loop recorders (79% considered them for recurrent syncope in high-risk patients) or electrophysiological studies (67% considered them in bifascicular block and inconclusive non-invasive testing). Non-pharmacological therapy was consistently considered by 68% of respondents; however, there was important variation regarding the choice of drug and device therapy. While revealing an increased awareness of syncope and good practice, our study identified important unmet needs regarding the optimal management of syncope and variable syncope guideline implementation.

Original languageEnglish
Pages (from-to)980-987
Number of pages8
Issue number6
Publication statusPublished - 1 Jun 2020


  • Cardiac syncope
  • Driving with syncope
  • EHRA survey
  • Event recorder
  • Implanted loop recorder
  • Orthostatic hypotension
  • Orthostatic intolerance
  • Reflex syncope
  • Syncope risk score
  • Syncope unit

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database


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