From the Guidelines
The most effective solution for cardiac syncope is to address the underlying cause, with treatment options including cardiac pacing, catheter ablation, antiarrhythmic drug therapy, and implantable cardioverter-defibrillator (ICD) implantation, as recommended by the 2009 European Heart Journal guidelines 1.
Treatment Options
The treatment of cardiac syncope depends on the underlying cause, with the primary goal being to prevent recurrent episodes and reduce the risk of sudden cardiac death.
- For arrhythmia-related syncope, cardiac pacing is indicated in patients with sinus node disease whom syncope is demonstrated to be due to sinus arrest (symptom ECG correlation) without correctable cause 1.
- Catheter ablation is indicated in patients with symptom-arrhythmia ECG correlation in both SVT and VT in the absence of structural heart disease 1.
- Antiarrhythmic drug therapy, including rate control drugs, is indicated in patients with syncope due to onset of rapid atrial fibrillation 1.
- ICD is indicated in patients with documented VT and structural heart disease 1.
Lifestyle Modifications
Lifestyle modifications are also important, including:
- Adequate hydration
- Avoiding triggers
- Rising slowly from lying/sitting positions
- Compression stockings for those with orthostatic components These interventions work by addressing the underlying cardiac abnormality, whether by maintaining appropriate heart rate, preventing dangerous arrhythmias, improving cardiac output, or reducing orthostatic blood pressure changes that can precipitate syncope episodes.
Structural Heart Disease
Structural heart disease causing syncope may require:
- Valve repair/replacement for stenotic valves
- Myectomy for hypertrophic cardiomyopathy
- Coronary revascularization for ischemic heart disease As noted in the 2001 European Heart Journal guidelines, treatment goals for structural cardiac or cardiopulmonary disease include prevention of symptom recurrence and reduction of mortality risk 2.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Cardiac Syncope Solutions
The solutions for cardiac syncope, also known as heart-related fainting spells, can be categorized into several approaches:
- Mechanism-specific treatment: This approach involves identifying the underlying mechanism of syncope and assigning it to either a hypotensive or bradycardic phenotype, which determines the choice of therapy 3.
- Withdrawal of hypotensive drugs: This is a treatment strategy for patients with cardiac syncope, particularly those with hypotensive phenotype 3.
- Applying fludrocortisone and midodrine: These medications are used to counteract hypotension in patients with cardiac syncope 3.
- Cardiac pacing: This is a treatment option for patients with cardiac syncope, particularly those with bradycardic phenotype 3, 4.
- Implantable cardioverter-defibrillator: This device is used to treat syncope due to arrhythmias, which is a common cause of cardiac syncope 4.
- Treatment of underlying heart disease: This is a crucial aspect of managing cardiac syncope, as the underlying heart disease needs to be addressed to prevent recurrences 4, 5.
Diagnostic Approaches
To determine the best course of treatment for cardiac syncope, a comprehensive diagnostic approach is necessary:
- History-taking: This is the most important aspect of the clinical assessment, as it helps identify the underlying cause of syncope 5, 6.
- Physical examination: A thorough physical examination is essential in identifying signs of underlying heart disease or other conditions that may be contributing to syncope 5, 6.
- Electrocardiogram: This test is used to identify arrhythmias or other cardiac abnormalities that may be causing syncope 4, 7.
- Echocardiography: This test is used to diagnose structural cardiac disease, which may be contributing to syncope 4.
- Implantable loop recorders: These devices are used to identify arrhythmias in patients with cardiac syncope 4.