Arrhythmias & electrophysiology
Mechanism of syncope: role of ambulatory blood pressure monitoring and cardiovascular autonomic function assessment
Authors' conclusion
The standardized 2STEPS protocol offers an easy-to-perform and time-saving diagnostic work-up allowing identification of the haemodynamic mechanism of loss of consciousness in most patients with autonomic syncope.
Study context
- Population
- Patients with severe autonomic syncope undergoing 24-h ambulatory BP monitoring and short cardiovascular autonomic function assessment (SCAFA: CSM if ≥40 years, passive standing, 'fast' head-up tilt)
- Participants
- 333 patients
- Exposure
- ≤40 years vs >40 years
- ≤40 yearsn = 102
- >40 yearsn = 231
- Outcome
- Diagnostic efficacy of the two-step assessment (any positive response identifying the haemodynamic mechanism)
Methodological detailsmulticentre, prospective, observational
- Multicentre
- Prospective
- Observational
Main finding
As reported in the abstract
Any positive response (haemodynamic mechanism identified) on 2-step assessment
- Any positive response, all patients
- 298 (89%)
- Any positive response, younger
- 92 [92%]
- Any positive response, older
- 134 [89%]
- Hypotensive phenotype
- 226 (68%)
- Bradycardic phenotype
- 21 (6%)
- Mixed phenotype
- 51 (15%)
Observational data: associations, not effects.
Further findings
More than one test positive
Positivity by test
- Ambulatory BP monitoring positive
- 60%
- CSM positive
- 15%
- Passive standing positive
- 3%
- Head-up tilt test positive
- 71%
Duration of SCAFA procedure
- Mean duration 25 min (IQR 20-32)
- 25
Inter-centre variability of CSM positivity rate
- Large inter-centre variability, significant after adjustment for demographic and clinical variables
- P = 0.003
Original publication
Mechanism of syncope: role of ambulatory blood pressure monitoring and cardiovascular autonomic function assessment. Eur Heart J. Published 30 December 2024. doi:10.
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