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Review
. 2024 Jan 26;13(3):727.
doi: 10.3390/jcm13030727.

Recent Advances and Future Directions in Syncope Management: A Comprehensive Narrative Review

Anna Maria Martone  1   2 , Iris Parrini  3 , Francesca Ciciarello  1 , Vincenzo Galluzzo  1 , Stefano Cacciatore  2 , Claudia Massaro  2 , Rossella Giordano  2 , Tommaso Giani  2 , Giovanni Landi  1 , Michele Massimo Gulizia  4 , Furio Colivicchi  5 , Domenico Gabrielli  6 , Fabrizio Oliva  7 , Giuseppe Zuccalà  1   2
Affiliations
Review

Recent Advances and Future Directions in Syncope Management: A Comprehensive Narrative Review

Anna Maria Martone et al. J Clin Med. .

Abstract

Syncope is a highly prevalent clinical condition characterized by a rapid, complete, and brief loss of consciousness, followed by full recovery caused by cerebral hypoperfusion. This symptom carries significance, as its potential underlying causes may involve the heart, blood pressure, or brain, leading to a spectrum of consequences, from sudden death to compromised quality of life. Various factors contribute to syncope, and adhering to a precise diagnostic pathway can enhance diagnostic accuracy and treatment effectiveness. A standardized initial assessment, risk stratification, and appropriate test identification facilitate determining the underlying cause in the majority of cases. New technologies, including artificial intelligence and smart devices, may have the potential to reshape syncope management into a proactive, personalized, and data-centric model, ultimately enhancing patient outcomes and quality of life. This review addresses key aspects of syncope management, including pathogenesis, current diagnostic testing options, treatments, and considerations in the geriatric population.

Keywords: cardiac syncope; electrophysiological study; falls; orthostatic hypotension; reflex syncope; syncope; syncope unit; tilt testing; transient loss of consciousness; vasovagal syncope.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study or in the writing of the manuscript.

Figures

Figure 1
Figure 1
Physiology of the baroreceptor reflex. Abbreviations: CN: cranial nerve; MAP: mean arterial pressure.
Figure 2
Figure 2
Continuous blood pressure curves showing normal recovery and the diagnostic criteria for initial delayed orthostatic hypotension. A decrease in the size of the red spots indicates a drop in blood pressure.
Figure 3
Figure 3
Diagnostic approach to syncope. Abbreviations: ECG: electrocardiogram; PNES: psychogenic non-epileptic seizure; PPS: psychogenic pseudoscope; OH: orthostatic hypotension; TIA: transient ischemic attack; TLOC: temporary loss of consciousness.
Figure 4
Figure 4
History recording in the initial assessment of syncope. Abbreviations: TLOC: temporary loss of consciousness.
Figure 5
Figure 5
Physical counter-pressure maneuvers.
See this image and copyright information in PMC

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