SYNCOPE ASSESSMENT AND TILT TESTING

It is not just a simple faint

WHAT IS SYNCOPE?

Syncope is defined as transient loss of consciousness (TLOC) due to cerebral hypoperfusion. [1] 

Although characterized by swift onset, short duration, and spontaneous complete recovery [1], “Syncope is an alarming event carrying the possibility of serious outcomes” [2], including potentially life-threatening heart condition and sudden cardiac death (SCD). [2.3]

FACTS & PREVALENCE

50% of the population will faint at least once in their lifetime. [3]

Syncope is cross generational phenomenon
Syncope presents across all age groups
Syncope is frequent which causes high financial costs

CHALLENGES

Syncope accounts for up to 3% of all emergency department (ED) visits5, however approximately 35% of patients with syncope remain undiagnosed in the ED. 4

Syncope is a diagnostic challenge with complex underlying mechanisms 2,8, requiring multidimensional approaches and individualized patient management.

DIAGNOSTIC PATH FOR UNEXPLAINED SYNCOPE

(acc. ESC Guidelines)

Syncope in the elderly
  • In many cases an efficient initial syncope evaluation can lead to diagnosis and start of treatment. [1]
  • In cases with uncertain diagnosis and suspected cardiac origin, cardiac evaluation is performed. [1]
  • In all other cases with frequent or severe episodes, cardiovascular autonomic function tests are recommended. This makes the majority of the patients. [1]
  • Head up Tilt Test (HUT) provides high diagnostic yield and is recommended by the ESC guidelines in case of suspicion of syncope after an initial inconclusive evaluation. [1,7]

CONTINUOUS MEASUREMENTS FOR CARDIOVASCULAR AUTONOMIC FUNCTION TESTS

As the onset of syncope happens extremely fast [1] only continuous measurements are helpful to caputure an event.

Task Force CARDIO Software SYNCOPE
  • Cardiovascular autonomic function tests require synchronized measurement of ECG (min 3 leads) and blood pressure, both in a continuous manner. [1]
  • Beat-to-beat blood pressure monitoring is recommended in several guidelines and expert consenses due to “the context of syncope blood pressure (BP) can change substantially in a few seconds”. [9]
  • “Conventional intermittent BP measurements allow one measurement per minute at best and are therefore unsuitable for syncope assessment.” [9]

 

“Our patients seek solutions, not only explanations.“ [1]

EXPERTS
ON SYNCOPE

“If I had the option to ask the industry for one thing in the future, it would be to have a device that can measure blood pressure at the time of syncope. This is my most important requirement.” [ Prof. Michele Brignole, Italy ]

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EASY TO USE INNOVATIVE TOOLS

With more than 20 years experience CNSystems provides you with state-of-the-art devices for high level syncope assessment.

  • Continuous blood pressure measurement from the unique CNAP® finger sensor
  • Advanced hemodynamic evaluation using CNAP® HD technology ) – non-invasive
  • Synchronized patient signals (incl. wireless 12-lead ECG)
  • Truly continuous recording when it matters most

TASK FORCE® TOUCH CARDIO

ALL YOU NEED TO SUPPORT YOUR CARDIOVASCULAR ASSESSMENT

Task Force Touch CARDIO Workstation
  • 24″ Touchscreen
  • Combination of CNAP® BP and NBP
  • Advanced hemodynamics using CNAP® HD technology
  • Optional 12-channel ECG
  • Accessory storage
  • 12-channel ECG
  • Pulse Rate
  • Continuous Blood Pressure
  • Cardiac Output
  • Systemic Vascular Resistance
  • Analog Input/Output signals
  • Easy & quick setup through unique finger sensor design
  • New Forearm Controller with integrated sizing tool
  • New Forearm Strap for safe & error-free fixation
  • Disinfectable finger sensor material
  • All parameters (BP, CO, SV, SVR..) from one sensor – no ICG electrodes required
  • Wireless Bluetooth communication
  • Electrode Contact Check 
  • State-of-the-art interface for smart user interaction with “touch” operation
  • Integrated screenshot tool
  • Set markers & comments at any time
  • Easy reporting & data export
  • Analog input/output interface
  • Post Processing tool easy data review & documentation (paperless)
  • Wireless printer support
  • Wireless connection to your network drive

SYNCOPE & TILT TESTING - USEFUL LINKS

There are fantastic platforms available treating the syncope topic. Find details on efficient diagnosis and treatment.

Do you have more questions?

We are always happy to help!

References:

[1] Brignole, M. et al. 2018 ESC Guidelines for the diagnosis and management of syncope. European Heart Journal vol. 39 1883–1948 (2018).

[2] Sutton, R., Ricci, F. & Fedorowski, A. Risk stratification of syncope: Current syncope guidelines and beyond. Auton. Neurosci. 238, 102929 (2021).

[3] Heartrhythmalliance: STARS. Take fainting to heart. WebPage (2022) https://www.heartrhythmalliance.org/stars/uk/take-fainting-to-heart 

[4] Sheldon, R. S. et al. 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope HHS Public Access. Hear. Rhythm 12, 41–63 (2015).

[5] Peeters, S. Y. G., Hoek, A. E., Mollink, S. M. & Huff, J. S. Syncope: risk stratification and clinical decision making. Emerg. Med. Pract. 16, 1–22; quiz 22–3 (2014).

[6] Goldberger, Z. D. et al. ACC/AHA/HRS Versus ESC Guidelines for the Diagnosis and Management of Syncope: JACC Guideline Comparison. J. Am. Coll. Cardiol. 74, 2410–2423 (2019).

[7] Barón-Esquivias, G. et al. Head-up tilt test diagnostic yield in syncope diagnosis. J. Electrocardiol. 63, 46–50 (2020).

[8] Dan, G. A. et al. Contemporary management of patients with syncope in clinical practice: an EHRA physician-based survey. Europace 22, 980–987 (2020).

[9] Thijs, R. D. et al. Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness. Auton. Neurosci. (2021) doi:10.1016/j.autneu.2021.102792.