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Kommentar zu der Leitlinie zur Diagnostik und Therapie von Synkopen der Europäischen Gesellschaft für Kardiologie 2009

Commentary on the 2009 European Society of Cardiology guidelines for the diagnosis and treatment of syncope

  • Leitlinien
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Die Leitlinie betont besonders die aktive Risikostratifizierung und die diagnostische Strategie des prolongierten EKG-Monitorings mittels implantierbarem Loop-Rekorder. Stellen einer Prima-vista-Diagnose oder zumindest einer Verdachtsdiagnose sowie die Risikostratifizierung, v. a. mittels EKG-Beurteilung und anamnestischer/klinischer Bewertung bestimmen die initiale Abklärung. Diagnostisch bleibt die Karotissinusmassage umstritten. Die elektrophysiologische Untersuchung zur Diagnostik vermuteter rhythmogener Synkopen hat an Stellenwert verloren. Der Loop-Rekorder ermöglicht hier die Rhythmusdokumentation bei künftiger Synkope. Eine routinemäßige neurologische Diagnostik ist nicht erforderlich. Eine standardisierte Abklärung führt zu hoher Aufklärungsrate. Therapieentscheidungen umfassen ICD oder Schrittmacher je nach Indikation bei rhythmogenen Synkopen bzw. Karotissinussynkope, zumeist Allgemeinmaßnahmen bei anderen Reflexsynkopen.

Abstract

The 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 hints. Carotid sinus massage as a diagnostic procedure remains controversial. Electrophysiological study for evaluation of suspected rhythmogenic 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 rhythmogenic syncope or carotid sinus syncope, and mostly general measures in cases of other reflex syncopes.

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Authors and Affiliations

  1. I. Medizinische Klinik, Klinikum Augsburg, Herzzentrum Augsburg-Schwaben, Stenglinstr. 2, 86156, Augsburg, Deutschland

    W. von Scheidt

  2. Zentrum für Herzrhythmusstörungen, Klinikum der Stadt Ludwigshafen, Herzzentrum Ludwigshafen, Ludwigshafen, Deutschland

    K. Seidl

  3. Herz- und Gefäßzentrum, Krankenhaus Neu-Bethlehem, Göttingen, Deutschland

    J.B. Dahm

  4. Medizinische Klinik, Friedrich-Ebert-Krankenhaus, Neumünster, Deutschland

    A. Schuchert

  5. Medizinische Klinik – Kardiologie, Nephrologie, Internistische Intensivmedizin, Ludwigsburg, Deutschland

    C. Wolpert

  6. Herzzentrum, Abteilung für Kardiologie und Pneumologie, Georg-August-Universität Göttingen, Göttingen, Deutschland

    M. Zabel

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  1. W. von Scheidt
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  2. K. Seidl
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  4. A. Schuchert
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  6. M. Zabel
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Correspondence to W. von Scheidt.

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von Scheidt, W., Seidl, K., Dahm, J. et al. Kommentar zu der Leitlinie zur Diagnostik und Therapie von Synkopen der Europäischen Gesellschaft für Kardiologie 2009. Kardiologe 5, 5–12 (2011). https://doi.org/10.1007/s12181-010-0316-9

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  • DOI: https://doi.org/10.1007/s12181-010-0316-9

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