Evaluating Patients With Unexplained Syncope

摘要

The transient nature of syncope makes its evaluation challenging. After an initial history, physical examination, and electrocardiogram, the cause of syncope can remain unexplained in up to 47% of patients. In this article, the authors review the three primary tests that are used to establish a diagnosis in patients with unexplained syncope after this initial evaluation: electrophysiologic testing, tilt testing, and ambulatory electrocardiographs monitoring.Whereas with electrophysiologic and tilt testing the diagnosis is made presumptively-inferred from simulation, not necessarily duplication, of syncopal conditions-ambulatory electrocardiographs monitoring offers the opportunity to definitively establish the heart rhythm during a syncopal event With the increasing use of implantable loop recorders, our understanding of syncope and its evaluation is evolving, A summary of the recent literature on implant-able loop recorders and the clinical implications of their use is included.