Second Cardiology Department, Attikon University Hospital, University of Athens, Rimini 1, 12462 Haidari Athens, Greece.
Europace. 2013 Dec;15(12):1812-5. doi: 10.1093/europace/eut354.
The aim of this European Heart Rhythm Association (EHRA) survey was to provide an insight into the current practice of work-up and management of patients with syncope among members of the EHRA electrophysiology research network. Responses were received from 43 centres. The majority of respondents (74%) had no specific syncope unit and only 42% used a standardized assessment protocol or algorithm. Hospitalization rates varied from 10% to 25% (56% of the centres) to >50% (21% of the centres). The leading reasons for hospitalization were features suggesting arrhythmogenic syncope (85% of respondents), injury (80%), structural heart disease (73%), significant comorbidities (54%), and older age (41%). Most widely applied tests were electrocardiogram (ECG), echocardiography, and Holter monitoring followed by carotid sinus massage and neurological evaluation. An exercise test, tilt table test, electrophysiological study, and implantation of a loop recorder were performed only if there was a specific indication. The use of a tilt table test varied widely: 44% of respondents almost always performed it when neurally mediated syncope was suspected, whereas 37% did not perform it when there was a strong evidence for neurally mediated syncope. Physical manoeuvres were the most widely (93%) applied standard treatment for this syncope form. The results of this survey suggest that there are significant differences in the management of patients with syncope across Europe, specifically with respect to hospitalization rates and indications for tilt table testing in neurally mediated syncope. The majority of centres reported using ECG, echocardiography, and Holter monitoring as their main diagnostic tools in patients with syncope, whereas a smaller proportion of centres applied specific assessment algorithms. Physical manoeuvres were almost uniformely reported as the standard treatment for neurally mediated syncope.
这项欧洲心律协会（EHRA）调查的目的是深入了解 EHRA 电生理研究网络成员对晕厥患者的检查和管理现状。调查共收到 43 个中心的回复。大多数（74%）的调查对象所在中心没有专门的晕厥单元，仅有 42%的中心使用标准化评估方案或算法。住院率从 10%到 25%（56%的中心）到>50%（21%的中心）不等。住院的主要原因是提示心律失常性晕厥的特征（85%的受访者）、受伤（80%）、结构性心脏病（73%）、严重合并症（54%）和年龄较大（41%）。最广泛应用的检查是心电图（ECG）、超声心动图和动态心电图监测，其次是颈动脉窦按摩和神经评估。如果有特定的适应证，通常会进行运动试验、倾斜台试验、电生理研究和植入环路记录仪。倾斜台试验的应用差异很大：44%的受访者在怀疑神经介导性晕厥时几乎总是进行该检查，而 37%的受访者在有明确神经介导性晕厥证据时不进行该检查。物理手法是该类晕厥最广泛（93%）应用的标准治疗方法。这项调查的结果表明，欧洲在晕厥患者的管理方面存在显著差异，特别是在神经介导性晕厥患者的住院率和倾斜台试验适应证方面。大多数中心报告说，在晕厥患者中使用心电图、超声心动图和动态心电图监测作为主要诊断工具，而较小比例的中心应用特定的评估算法。物理手法几乎被一致报告为神经介导性晕厥的标准治疗方法。
