Search

Aims Aim of the present study was the development and the subsequent validation of a simple risk classification system for patients presenting with syncope to the emergency departments. Methods and results A group of 270 consecutive patients (145 females, mean age 59.5 years) presenting with syncope to the emergency departments of six community hospitals of the Lazio region of Italy was used as a derivation cohort for the development of the risk classification system. Data from the baseline clinical history, physical examination and electrocardiogram were used to identify independent predictors of total mortality within the first 12 months after the initial evaluation. Multivariate analysis allowed the recognition of the following predictors of mortality: (1) age >65 years; (2) cardiovascular disease in clinical history; (3) syncope without prodromes; and (4) abnormal electrocardiogram. The OESIL (Osservatorio Epidemiologico sulla Sincope nel Lazio) score was calculated by the simple arithmetic sum of the number of predictors present in every single patient. Mortality increased significantly as the score increased in the derivation cohort (0% for a score of 0, 0.8% for 1 point; 19.6% for 2 points; 34.7% for 3 points; 57.1% for 4 points; \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(p{

Aims This study was undertaken to evaluate the epidemiological features and the prognostic implications of syncope in young athletes. Methods and results A cohort of 7568 young athletes (5132 males, 2436 females, aged 16.2±2.4) underwent a pre-participation evaluation. A syncopal spell in the last 5 years was reported by 474 athletes (6.2%). Syncope was unrelated with exercise in 411 athletes (86.7%), post-exertional in 57 (12.0%) and exertional in 6 (1.3%). All episodes of non-exertional or post-exertional syncope had the typical features of neurally-mediated fainting. The 6 athletes with exertional syncope underwent further testing allowing the diagnosis of hypertrophic cardiomyopathy in one case, and of right ventricular outflow tract tachycardia in another. The remaining 4 athletes only showed a positive response to tilt-testing. All athletes were followed for 6.4±3.1 years, during 48 066.6 person-years of follow-up. The recurrence rate was 20.3 per 1000 subject-years in athletes with non-exertional, and 19.2 per 1000 subject-years in athletes with post-exertional syncope. The incidence of first report of syncope was 2.2 per 1000 subject-years for non-exertional and 0.26 per 1000 subjects-years for post-exertional spells. No other adverse event was noted during follow-up. Conclusions In young athletes, syncope occurring before the initial pre-participation screening has a neurally-mediated origin in most cases and shows a low recurrence rate. Exercise-related syncope is infrequent and is not associated with an adverse outcome in subjects without cardiovascular abnormalities. The incidence of new syncope during competitive activity is particularly low.

Background—This clinical investigation was performed to compare the effects of permanent dual-chamber cardiac pacing with pharmacological therapy in patients with recurrent vasovagal syncope. Methods and Results—Patients from 14 centers were randomized to receive either a DDD pacemaker provided with rate-drop response function or the β-blocker atenolol at the dosage of 100 mg once a day. Inclusion criteria were age >35 years, ≥3 syncopal spells in the preceding 2 years, and positive response to tilt table testing with syncope occurring in association with relative bradycardia. The primary outcome was the first recurrence of syncope after randomization. Enrollment was started in December 1997, and the first formal interim analysis was performed on July 30, 2000. By that time, 93 patients (38 men and 55 women; mean age, 58.1±14.3 years) had been enrolled and randomized, although follow-up data were available for all patients (46 patients in the pacemaker arm, 47 patients in the pharmacological arm). The int...