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Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research
Interdisciplinary Working Group; and the American College of Cardiology Foundation In Collaboration With
the Heart Rhythm Society. J Am Coll Cardiol. 2006;47:473-484.
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Del Rosso A, Ungar A, Maggi R, et al. Clinical predictors of

Brignole M, Alboni P, Benditt DG, et al. Guidelines on Management
(Diagnosis and Treatment) of Syncope: Update 2004 Executive Summary,
The Task Force on Syncope, European Society of Cardiology. Eur Heart
J. 2004;25:2054-2072.
An update from the European Task Force guidelines in 2001; details the
evaluation, diagnostic workup, and treatment for syncope patients.
Grubb BP. Clinical practice. Neurocardiogenic syncope. N Engl J Med.
2005;352:1004-1010.
A comprehensive review of the evaluation and management of neurocardiogenic
syncope. Syncope guidelines are reviewed as mell.
Soteriades ES, Evans JC, Larson MG, et al. Incidence and prognosis of
syncope. N Engl J Med. 2002;347:878-885.
Participants in the Framingham Heart Study were evaluated for the incidence and
etiology of syncopal episodes from 1971 to 1998. This study demonstrates that the
prognosis over many years of follow-up is dependent on the etiology of the syncopal
euent.
Strickberger SA, Benson DW, Biaggioni I, et al. AHA/ACCF Scientific
Statement on the Evaluation of Syncope: From the American Heart Association
Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular
Disease in the Young, and Stroke, and the Quality of Care and Outcomes
Research Interdisciplinary Working" Group; and the American College of
Cardiology Foundation: In Collaboration With the Ileart Rhythm Society:
Endorsed by the American Autonomic Society. Circulation. 2006;113:316-327.
Outlines the evaluation process and differential diagnosis in patients with syncope as
defined by an expert committee assembled by the American Heart Association and
American College of Cardiology.
Connolly ST, Sheldon R, Roberts RS, Gent M. The North American
Vasovagal Pacemaker Study (VIPS). A randomized trial of perinanent
cardiac pacing for the prevention of vasovagal syncope. J Am Coll Cardiol.
1999;33:16-20.
cardiac syncope at initial evaluation in patients referred
urgently to a general hospital: the EGSYS score. Heart.
2008;94:1620-1626.
A prospective cohort study used to devise the EGSYS scoring system for
Syncope patients. The scoring system was then validated with another
prospective cohort. The scoring system was devised to better detect
those patients with syncope due to a cardiac cause.
Kapoor WIN. Is there an effective treatment for neurally
mediated syncope? JAMA. 2003;289:2272-2275.
Tbh accompanying editorial to the publisbed VIPS II results.
Raviele A, Giada F, Menozzi C, et al. A randomized, double-
blind, placebo-controlled study of permanent cardiac pacing for
the treatment of recurrent tilt-induced vasovagal syncope. The
vasovagal syncope and pacing trial (SYNPACE). Eur Heart J.
2004;25:1741-1748.
Twenty-nine patients underwent pacemaker implantation and were
randomized to pacemaker treatment on versus off. There was no
significant reduction in syncopal events in the pacemaker-on group.
Schladenhaufen R, Feilinger S, Pollack M, et al. Application
of San Francisco Syncope Rule in elderly ED patients. Am
J Emerg Med. 2008,26:773-778.
The San Francisco Syncope Rule is a simple algorithm to aid physicians
evaluating patients with syncope for their risk for adverse outcomes such
as a dangerous cardiac arrythmia. This study shows how the algorithm
applies to the elderly population.
Venugopal D, Jhanjee R, Benditt DG. Current management of
syncope: focus on drug therapy. Am J Cardiooasc Drugs.
2007;7:3 99-411.
Comprehensive review discussing the various pharmacotherapies
available for neurocardiogenic syncope.

A nonblinded controlled study that randomized patients to pacemaker implantation

and pacemaker therapy versus no pacemaker There was a marked treatment effect
in the pacemaker group leading to early termination of the study. However; given
the results of VPS II, this is now felt to be largely due to placebo effect.

Connolly ST, Sheldon R, Thorpe KE, et al. Pacemaker therapy for

prevention of syncope in patients with recurrent severe vasovagal
syncope: Second Vasovagal Pacemaker Study (VIPS II): a randomized trial.
JAMA. 2003;289:2224-2229.

A double-blinded controlled trial in which all subjects underwent pacemaker

implantation, followed by randomization to either a pacing protocol or pacemaker
inactivation for the duration of the study. Pacemaker therapy did not reduce the
incidence of recurrent vasovagal therapy