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Updated: Jun 2, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
[What is new in the 2009 ESC guidelines?]
1I. Medizinische Klinik, Klinikum Augsburg, Herzzentrum Augsburg-Schwaben, Deutschland. wolfgang.scheidt@klinikum-augsburg.de
Insights
The 2009 ESC guideline recommends active risk stratification and implantable loop recorders for diagnosing syncope. Standardized evaluations help minimize unexplained syncope cases and guide appropriate therapy.
Area of Science:
- Cardiology
- Clinical Electrophysiology
Context:
- The 2009 European Society of Cardiology (ESC) guideline for syncope management.
- Increasing need for effective syncope diagnostic strategies.
Purpose:
- To outline the diagnostic and therapeutic approach for syncope based on the 2009 ESC guidelines.
- To emphasize risk stratification and the role of prolonged ECG monitoring.
Summary:
- Active risk stratification and diagnostic hypothesis formation are key initial steps.
- Implantable loop recorders are crucial for rhythm documentation during syncope.
- Carotid sinus massage utility is debated; electrophysiological studies have decreasing relevance for arrhythmogenic syncope.
- Standardized evaluation protocols reduce unexplained syncope rates.
- Therapeutic decisions involve device implantation (ICD, pacemaker) or general measures based on syncope type.
Impact:
- Facilitates a systematic approach to syncope diagnosis and management.
- Improves the identification of causes for syncope, leading to targeted therapies.
- Reduces the incidence of unexplained syncope through standardized diagnostic pathways.
Abstract:
The 2009 ESC guideline emphasizes active risk stratification and the diagnostic strategy of prolonged ECG monitoring using an implantable loop recorder. The initial evaluation aims at establishing a prima vista diagnosis or at least a diagnostic hypothesis and risk stratification according to ECG criteria and clinical findings. Carotid sinus massage as a diagnostic procedure remains controversial. Electrophysiological study for evaluation of suspected arrhythmogenic syncope is of decreasing relevance. The loop recorder enables documentation of the rhythm during a subsequent syncope. Neurological work-up is not routinely recommended. A standardized evaluation minimizes the rate of unexplained syncopes. Therapeutic decisions include ICD or pacemaker, as indicated in cases of arrhythmogenic syncope or carotid sinus syncope, and mostly general measures in case of other reflex syncopes.
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