ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2021
Diagnostic yield and accuracy in a tertiary referral syncope unit validating the ESC guideline on syncope: a prospective cohort study.
Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Head-up tilt testing in older syncope patients: a systematic review.Age and ageing · 2025Pooled it
- Indications, contraindications, and step-by-step methodology for performing carotid sinus massage in patients presenting with syncope : A scientific statement of an Ad Hoc Syncope Consortium endorsed by: the European Autonomic Society (EFAS), Gruppo Italiano Multidisciplinare Syncope (GIMSI) and European Geriatric Medicine Society (EuGMS).Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2026Review
- Reproducibility of orthostatic blood pressure measurements in a middle-aged population-based cohort: a one-year follow-up study.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2026Article
- Haemodynamics of (pre)syncope during carotid sinus massage: a beat-to-beat analysis of haemodynamic parameters during carotid sinus massage.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2026Article
- Syncope diagnostic evaluation in a southern European population: patterns of clinical practice and cost implications.BMC health services research · 2026Observational
- Design and rationale of the RISC-trial: multicentreEuropean heart journal open · 2026Article
- Now is the time to take syncope seriously.The British journal of cardiology · 2026Article
- Carotid sinus massage in clinical practice: the Six-Step-Method.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Article
- [Diagnostics and treatment of syncope].Herz · 2024Article
- Interventions aimed to increase average 24-h systolic blood pressure reduce blood pressure drops in patients with reflex syncope and orthostatic intolerance.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Observational
- A cross-sectional nationwide survey of guideline based syncope units in the Netherlands: the SU-19 score-a novel validation for best practices.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Article
- Diagnostic and societal impact of implementing the syncope guidelines of the European Society of Cardiology (SYNERGY study).BMC medicine · 2023Article
- Twenty-five years of research on syncope.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Article
- Definitive aetiology of unexplained syncope after cardiovascular autonomic tests in a tertiary syncope unit.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Article
- Syncope Diagnosis at Referral to a Tertiary Syncope Unit: An in-Depth Analysis of the FAST II.Journal of clinical medicine · 2023Article
- Diagnosis and treatment of orthostatic hypotension.The Lancet. Neurology · 2022Review
- Early and late-onset syncope: insight into mechanisms.European heart journal · 2022Article
- Sleep syncope: a prospective cohort study.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2022Article
- Sleep syncope: a new clinical entity or just a vasovagal syncope during wakefulness after sleep onset?Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2022Article
- Diagnostic criteria for initial orthostatic hypotension: a narrative review.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2021Review
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsTo assess in patients with transient loss of consciousness the diagnostic yield, accuracy, and safety of the structured approach as described in the ESC guidelines in a tertiary referral syncope unit. METHODS AND
resultsProspective cohort study including 264 consecutive patients (≥18 years) referred with at least one self-reported episode of transient loss of consciousness and presenting to the syncope unit between October 2012 and February 2015. The study consisted of three phases: history taking (Phase 1), autonomic function tests (AFTs) (Phase 2), and after 1.5-year follow-up with assessment by a multidisciplinary committee (Phase 3). Diagnostic yield was assessed after Phases 1 and 2. Empirical diagnostic accuracy was measured for diagnoses according to the ESC guidelines after Phase 3. The diagnostic yield after Phase 1 (history taking) was 94.7% (95% CI: 91.1-97.0%, 250/264 patients) and increased to 97.0% (93.9-98.6%, 256/264 patients) after Phase 2. The overall diagnostic accuracy (as established in Phase 3) of the Phases 1 and 2 diagnoses was 90.6% (95% CI: 86.2-93.8%, 232/256 patients). No life-threatening conditions were missed. Three patients died, two unrelated to the cause of transient loss of consciousness, and one whom remained undiagnosed.
conclusionA clinical work-up at a tertiary syncope unit using the ESC guidelines has a high diagnostic yield, accuracy, and safety. History taking (Phase 1) is the most important diagnostic tool. Autonomic function tests never changed the Phase 1 diagnosis but helped to increase the certainty of the Phase 1 diagnosis in many patients and yield additional diagnoses in patients who remained undiagnosed after Phase 1. Diagnoses were inaccurate in 9.4%, but no serious conditions were missed. This is adequate for clinical practice.
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