Syncopes

Canadian Cardiovascular Society Clinical Practice Update on the Assessment and Management of Syncope, Canadian journal of Cardiology, VOLUME 36, ISSUE 8, P1167-1177, AUGUST 01, 2020

Multicenter Emergency Department Validation of the Canadian Syncope Risk Score [published online ahead of print, 2020 Mar 23]. Thiruganasambandamoorthy V, Sivilotti MLA, Le Sage N, et al. JAMA Intern Med. 2020;180(5):1-8. doi:10.1001/jamainternmed.2020.0288

Duration of Electrocardiographic Monitoring of Emergency Department Patients With Syncope. Thiruganasambandamoorthy V, Rowe BH, Sivilotti MLA, McRae AD, Arcot K, Nemnom MJ, Huang L, Mukarram M, Krahn AD, Wells GA, Taljaard M. Circulation. 2019 Mar 12;139(11):1396-1406. doi: 10.1161/CIRCULATIONAHA.118.036088. PMID: 30661373

Serious underlying arrhythmia was often identified within the first 2 hours of ED arrival for CSRS low-risk patients and within 6 hours for CSRS medium- and high-risk patients. Outpatient cardiac rhythm monitoring for 15 days for selected medium-risk patients and all high-risk patients discharged from the hospital should also be considered.

Predictive Accuracy of Electrocardiographic Monitoring of Patients With Syncope in the Emergency Department: The SyMoNE Multicenter Study. Solbiati M, Dipaola F, Villa P, Seghezzi S, Casagranda I, Rabajoli F, Fiorini E, Porta L, Casazza G, Voza A, Barbic F, Montano N, Furlan R, Costantino G. Acad Emerg Med. 2020 Jan;27(1):15-23. doi: 10.1111/acem.13842. Epub 2019 Dec 19. PMID: 31854141

Although the overall diagnostic accuracy of ECG monitoring is fair, its sensitivity at >12 hours' duration is substantially higher. These results suggest that prolonged (>12 hours) monitoring is a safe alternative to hospital admission in the management of non-low-risk patients with syncope in the ED.

Approach to syncope in the emergency department, Reed MJ, Emerg Med J Published Online First: 23 November 2018. doi: 10.1136/emermed-2018-207767

2018 ESC Guidelines for the diagnosis and management of syncope, European Heart Journal, ehy037, https://doi.org/10.1093/eurheartj/ehy037, Published: 19 March 2018

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: Executive Summary; J Am Coll Cardiol. 2017 Mar 9. pii: S0735-1097(17)30792-1. doi: 10.1016/j.jacc.2017.03.002

Algorithme décisionnel

Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association Position Statement on the Approach to Syncope in the Pediatric Patient, Canadian journal of cardiology, February 2017Volume 33, Issue 2, Pages 189–198

Prevalence of Pulmonary Embolism Among Emergency Department Patients With Syncope: A Multicenter Prospective Cohort Study. Thiruganasambandamoorthy V, Sivilotti MLA, Rowe BH, McRae AD, Mukarram M, Malveau S, Yagapen AN, Sun BC; North American Syncope Consortium. Ann Emerg Med. 2019 Jan 25. pii: S0196-0644(18)31535-X. doi: 10.1016/j.annemergmed.2018.12.005. [Epub ahead of print] PMID: 30691921

Prevalence of Pulmonary Embolism in Patients Presenting With Syncope. A Systematic Review and Meta-Analysis, Am J Emerg Med. 2017 Sep 14, http://dx.doi.org/10.1016/j.ajem.2017.09.015

Conclusion: The estimated prevalence of PE in patients presenting with syncope is low. The Prandoni et al. estimates are significantly higher, suggesting a possible site effect, accrual bias, or investigation strategy. These and the prognostic impact of higher PE prevalence require understanding before changes in practice.