Skip Navigation

European Heart Journal 2001 22(15):1256-1306; doi:10.1053/euhj.2001.2739
Copyright © 2001 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Wieling, W
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Wieling, W
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Task Force Report

Guidelines on management (diagnosis and treatment) of syncope

Task Force on Syncope, European Society of Cardiology, M Brignole, MD FESC, Chairmana,f1, P Alboni, MDb, D Benditt, MDc, L Bergfeldt, MD FESCd, J.J Blanc, MD FESCe, P.E Bloch Thomsen, MDf, J.G van Dijk, MDg, A Fitzpatrick, MDh, S Hohnloser, MD FESCi, J Janousek, MDj, W Kapoor, MDk, R.A Kenny, MDl, P Kulakowski, MD FESCm, A Moya, MD FESCn, A Raviele, MD FESCo, R Sutton, DscMed FESCp, G Theodorakis, MD FESCq and W Wieling, MDr

a Department of Cardiology and Arrhythmologic Centre, Ospedali Riuniti, Lavagna, Italy
b Divisione di Cardiologia, Ospedale Civile, Cento, Italy
c Cardiac Arrhythmia Service, Cardiovascular Division, University of Minnesota, Minneapolis, U.S.A.
d Electrophysiology & Arrhythmia Service, Department of Cardiology, Thoracic Clinics, Karolinska Hospital, Stockolm, Sweden
e Departement de Cardiologie, Hopital de la Cavale Blanche, CHU de Brest, France
f Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
g Department of Neurology and Clinical Neurophysiology, Leiden University Medical Centre, Leiden, The Netherlands
h Manchester Heart Centre, Royal Infirmary Manchester, UK
i Medizinische Klinik IV, Kardiologie Klinicum der JW Goethe University, Frankfurt, Germany
j Kardiocentrum, University Hospital Motol, Prague, Czech Republic
k Department of Medicine, University of Pittsburg, Pittsburg, Pennsylvania, U.S.A.
l Institute for the Health of the Elderly, University of Newcastle Upon Tyne, Royal Victoria Infirmary, Newcastle upon Tyne, U.K.
m Department of Cardiology, Med. Centre of Postgraduate Education, Grochowski Hospital, Warsaw, Poland
n Department of Cardiology, Hospital General Vall d'Hebron, Barcelona, Spain
o Divisione di Cardiologia, Ospedale Umberto I, Mestre-Venice, Italy
p Department of Cardiology, Royal Brompton Hospital, London, U.K.
q 2° Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
r Academic Medical Centre, University of Amsterdam, Department of Internal Medicine, Amsterdam, The Netherlands

Abstract

No Abstract

f1 Correspondence: Michele Brignole, MD, FESC, Department of Cardiology and Arrhythmologic Centre, Ospedali Riuniti, 16033 Lavagna, Italy.

This document has been reviewed by members of the Committee for Practice Guidelines (formerly Committee for Scientific and Clinical Initiatives) and by the members of the Board of the European Society of Cardiology (see Appendix 1), who approved the document on 8 March 2001. The full text of this document is available on the website of the European Society of Cardiology in the section ‘Scientific Information’, Guidelines.

References

  1. Rossen R, Kabat H, Anderson JP. Acute arrest of cerebral circulation in man. Arch Neurol Psychiatr. 1943;50:510–528
  2. Lempert T, Bauer M, Schmidt D. Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia. Ann Neurol. 1994;36:233–237[CrossRef][ISI][Medline]
  3. Hoefnagels WAJ, Padberg GW, Overweg J. Transient loss of consciousness: the value of the history for distinguishing seizure from syncope. J Neurol. 1991;238:39–43[CrossRef][ISI][Medline]
  4. Rowell LB. Human Cardiovascular control. Oxford: Oxford University Press; 1993.
  5. Scheinberg P, Blackburn I, Rich M. Effects of aging on cerebral circulation and metabolism. Arch Neurol Psych. 1953;70:77–85
  6. Scheinberg P, Blackburn I, Rich M, Saslaw M. Effects of aging on cerebral circulation and metabolism. Effect of again on cerebral circulation and metabolism. Arch Neurol Psych. 1953;70:77–85
  7. Dandona P, James IM, Newbury PA. Cerebral blood flow in diabetes mellitus: evidence of abnormal cerebral vascular reactivity. Br Med J. 1978;2:325–326[ISI][Medline]
  8. Hainsworth R. Syncope and fainting: classification and pathophysiological basis. Mathias CJ, Bannister R. Autonomic Failure. A textbook of clinical disorders of the autonomic nervous system. Oxford: Oxford University Press; 1999. p. 428–436
  9. Smit AAJ, Halliwill JR, Low PA, Wieling W. Topical Review. Pathophysiological basis of orthostatic hypotension in autonomic failure. J Physiol. 1999;519:1–10[Abstract/Free Full Text]
  10. Sheldon R, Killam S. Methodology of isoproterenol-tilt table testing in patients with syncope. J Am Coll Cardiol. 1992;19:773–779[Abstract]
  11. Gibson GE, Pulsinelli W, Blass JP. Brain dysfunction in mild to moderate hypoxia. Am J Med. 1981;70:1247–1254[CrossRef][ISI][Medline]
  12. Johnson AM. Aortic stenosis, sudden death, and the left ventricular baroreceptors. Br Heart J. 1971;33:1–5[Free Full Text]
  13. Leitch JW, Klein GJ, Yee R. Syncope associated with supraventricular tachycardia: An expression of tachycardia or vasomotor response. Circulation. 1992;85:1064–1071[Abstract/Free Full Text]
  14. Brignole M, Gianfranchi L, Menozzi C. Role of autonomic reflexes in syncope associated with paroxysmal atrial fibrillation. J Am Coll Cardiol. 1993;22:1123–1129[Abstract]
  15. Alboni P, Menozzi C, Brignole M. An abnormal neural reflex plays a role in causing syncope in sinus bradycardia. J Am Coll Cardiol. 1993;22:1130–1134[Abstract]
  16. Dermkasian G, Lamb LE. Syncope in a population of healthy young adults. JAMA. 1958;168:1200–1207[ISI][Medline]
  17. Savage DD, Corwin L, McGee DL. Epidemiologic features of isolated syncope: The Framingham Study. Stroke. 1985;16:626–629[Abstract/Free Full Text]
  18. Lipsitz LA, Pluchino FC, Wei JY, Rowe JW. Syncope in an elderly institutionalized population: prevalence, incidence and associated risk. Q J Med. 1985;55:45–54[ISI][Medline]
  19. Day SC, Cook EF, Funkenstein H, Goldma L. Evaluation and outcome of emergency room patients with transient loss of consciousness. Am J Med. 1982;73:15–23[CrossRef][ISI][Medline]
  20. Silverstein MD, Singer DE, Mulley A. Patients with syncope admitted to medical intensive care units. JAMA. 1982;248:1185–1189[Abstract]
  21. Morichetti A, Astorino G. Epidemiological and clinical findings in 697 syncope events. Minerva Medica. 1998;89:211–220[Medline]
  22. Lewis DA, Dhala A. Syncope in pediatric patient. Pediatr Clin North Am. 1999;46:205–219[CrossRef][ISI][Medline]
  23. Murdoch BD. Loss of consciousness in healthy South African men: incidence, causes and relationship to EEG abnormality. SA Med J. 1980;57:771–774
  24. Lamb L, Green HC, Combs JJ, Cheesman SA, Hammond J. Incidence of loss of consciousness in 1980 Air Force personnel. Aerospace Med. 1960;12:973–988
  25. Feruglio GA, Perraro F. Rilievi epidemiologici sulla sincope nella popolazione generale e come causa di ricovero. G Ital Cardiol. 1987;17:11–13
  26. Martin GJ, Adams SL, Martin HG. Prospective evaluation of syncope. Ann Emerg Med. 1984;13:499–504[CrossRef][ISI][Medline]
  27. Kapoor W, Karpf M, Wieand S, Peterson J, Levey G. A prospective evaluation and follow-up of patients with syncope. N Engl J Med. 1983;309:197–204[Abstract]
  28. Kapoor W. Evaluation and outcome of patients with syncope. Medicine. 1990;69:169–175
  29. Kapoor WN, Hanusa B. Is syncope a risk factor for poor outcomes? Comparison of patients with and without syncope. Am J Med. 1996;100:646–655[CrossRef][ISI][Medline]
  30. Middlekauff H, Stevenson W, Stevenson L, Saxon L. Syncope in advanced heart failure: high risk of sudden death regardless of origin of syncope. J Am Coll Cardiol. 1993;21:110–116[Abstract]
  31. Ross J, Braunwald E. Aortic stenosis. Circulation. 1968;38:61–67
  32. McKenna W, Deanfield J, Faraqui A, England D, Oakley C, Goodwin J. Prognosis in hypertrophic cardiomyopathy: role of age and clinical, electrocardiographic and hemodynamic features. Am J Cardiol. 1981;47:532–538[CrossRef][ISI][Medline]
  33. Dalal P, Fujisic K, Hupart P, Schwietzer P. Arrhythmogenic right ventricular dysplasia: a review. Cardiology. 1994;85:361–369[ISI][Medline]
  34. N Engl J Med. 1983;309:331–336[Abstract]
  35. Martin TP, Hanusa BH, Kapoor WN. Risk stratification of patients with syncope. Annals Emerg Med. 1997;29:459–466
  36. Kapoor WN, Smith M, Miller NL. Upright tilt testing in evaluating syncope: a comprehensive literature review. Am J Med. 1994;97:78–88[CrossRef][ISI][Medline]
  37. Raviele A, Proclemer A, Gasparini G. Long-term follow-up of patients with unexplained syncope and negative electrophysiologic study. Eur Heart J. 1989;10:127–132[Abstract/Free Full Text]
  38. Kapoor W, Peterson J, Wieand HS, Karpf M. Diagnostic and prognostic implications of recurrences in patients with syncope. Am J Med. 1987;83:700–708[CrossRef][ISI][Medline]
  39. Oh JH, Hanusa BH, Kapoor WN. Do symptoms predict cardiac arrhythmias and mortality in patients with syncope? Arch Intern Med. 1999;159:375–380[Abstract/Free Full Text]
  40. Kapoor WN, Fortunato M, Hanusa SH, Schulberg HC. Psychiatric illnesses in patients with syncope. Am J Med. 1995;99:505–512[CrossRef][ISI][Medline]
  41. Rose MS, Koshman ML, Spreng S, Sheldon R. The relationship between health related quality of life and frequency of spells in patients with syncope. J Clin Epidemiol. 2000;35:1209–1216
  42. Sheldon R, Rose S, Flanagan P, Koshman ML, Killam S. Risk factors for syncope recurrence after a positive tilt-table test in patients with syncope. Circulation. 1996;93:973–981[Abstract/Free Full Text]
  43. Linzer M, Pontinen M, Gold DT, Divine GW, Felder A, Brooks WB. Impairment of physical and psychosocial function in recurrent syncope. J Clin Epidemiol. 1991;44:1037–1043[CrossRef][ISI][Medline]
  44. Kapoor W, Karpf M, Maher Y. Syncope of unknown origin: the need for a more cost-effective approach to its diagnostic evaluation. JAMA. 1982;247:2687–2691[Abstract]
  45. Nyman J, Krahn A, Bland P, Criffiths S, Manda V. The costs of recurrent syncope of unknown origin in elderly patients. PACE. 1999;22:1386–1394
  46. Alboni P, Brignole M, Menozzi C. The diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Cardiol. 2001;37:1921–1928[Abstract/Free Full Text]
  47. Calkins H, Shyr Y, Frumin H, Schork A, Morady F. The value of clinical history in the differentiation of syncope due to ventricular tachycardia, atrioventricular block and neurocardiogenic syncope. Am J Med. 1995;98:365–373[CrossRef][ISI][Medline]
  48. Oh JH, Hanusa BH, Kapoor WN. Do symptoms predict cardiac arrhythmias and mortality in patients with syncope? Arch Intern Med. 1999;159:375–380[Abstract/Free Full Text]
  49. Neurology. 1996;46:1470[Free Full Text]
  50. Recchia D, Barzilai B. Echocardiography in the evaluation of patients with syncope. J Gen Intern Med. 1995;10:649–655[ISI][Medline]
  51. Panther R, Mahmood S, Gal R. Echocardiography in the diagnostic evaluation of syncope. J Am Soc Echocardiogr. 1998;11:294–298[CrossRef][ISI][Medline]
  52. Krumholz HM, Douglas PS, Goldman L, Waksmonski C. Clinical utility of transthoracic two-dimensional and Doppler echocardiography. J Am Coll Cardiol. 1994;24:125–131[Abstract]
  53. Angeles K, Betzu R, Gould LA. Diagnosis of atrial septal aneurysm by two-dimensional echocardiography—a case report. Angiology. 1992;43:693–696[Abstract/Free Full Text]
  54. Hoegholm A, Clementsen P, Mortensen SA. Syncope due to right atrial thromboembolism: diagnostic importance of two-dimensional echocardiography. Acta Cardiol. 1987;42:469–473[ISI][Medline]
  55. Bogaert AM, De Scheerder I, Colardyn F. Successful treatment of aortic rupture presenting as a syncope: the role of echocardiography in diagnosis. Int J Cardiol. 1987;16:212–214[CrossRef][ISI][Medline]
  56. Omran H, Fehske W, Rabahieh R. Valvular aortic stenosis: risk of syncope. J Heart Valve Dis. 1996;5:31–34[ISI][Medline]
  57. Sakuma T, Kakihana M, Togo T. Mitral valve prolapse syndrome with coronary artery spasm: a possible cause of recurrent ventricular tachycardia. Clin Cardiol. 1985;8:306–308[ISI][Medline]
  58. Said S. Doppler echocardiographic findings in coronary-pulmonary fistula. Int J Cardiol. 1989;25:343–346[CrossRef][ISI][Medline]
  59. Herr W, Schwarting A, Wittig B. Enormous hemangiosarcoma of the heart. Clin Investig. 1994;72:372–376[ISI][Medline]
  60. Nienaber CA, Hiller S, Spielmann RP, Geiger M, Kuck KH. Syncope in hypertrophic cardiomyopathy: multivariate analysis of prognostic determinants. J Am Coll Cardiol. 1990;15:948–955[Abstract]
  61. Peters MN, Hall RJ, Cooley DA, Leachman RD, Garcia E. The clinical syndrome of atrial myxoma. JAMA. 1974;230:695–701[CrossRef][ISI][Medline]
  62. Alcocer JJ, Katz WE, Hattler BG. Surgical treatment of lipomatous hypertrophy of the interatrial septum. Ann Thorac Surg. 1998;65:1784–1786[Abstract/Free Full Text]
  63. Sheldon R, Isaac D. Metastatic melanoma to the heart presenting with ventricular tachycardia. Chest. 1991;99:1296–1298[Abstract/Free Full Text]
  64. Grigg LE, Downey W, Tatoulis J, Hunt D. Benign congenital intracardiac thyroid and polycystic tumor causing right ventricular outflow tract obstruction and conduction disturbance. J Am Coll Cardiol. 1987;9:227
  65. Alam M, Silverman N. Apical left ventricular lipoma presenting as syncope. Am Heart J. 1993;125:1788–1790[CrossRef][ISI][Medline]
  66. Rowland TW, Twible EA, Norwood WI, Keane JF. Partial absence of the left pericardium. Diagnosis by two-dimensional echocardiography. Am J Dis Child. 1982;136:628–630[Abstract]
  67. Franke H. Uber das karotissinus-syndrome und den sogennanten hyperactiven karotissinus reflex. Stuttgart: Fridrich-Kave Schattaueur Verlag; 1963.
  68. Blanc JJ, L'heveder G, Mansourati J, Tea SH, Guillo Ph, Mabin D. Assessment of newly recognized association: carotid sinus hypersensitivity and denervation of sternocleidomastoid muscles. Circulation. 1997;95:2548–2551[Abstract/Free Full Text]
  69. O'Mahoney D. Pathophysiology of carotid sinus hypersensitivity in elderly patients. Lancet. 1995;346:950–952[CrossRef][ISI][Medline]
  70. Tea SH, Mansourati J, L'Heveder G, Mabin D, Blanc JJ. New insights into the pathophysiology of carotid sinus syndrome. Circulation. 1996;93:1411–1416[Abstract/Free Full Text]
  71. Brignole M, Menozzi C, Lolli G, Oddone D, Gianfranchi L, Bertulla A. Validation of a method for choice of pacing mode in carotid sinus syndrome with or without sinus bradycardia. PACE. 1991;14:196–203
  72. McIntosh SJ, Lawson J, Kenny RA. Clinical characteristics of vasodepressor, cardioinhibitory and mixted carotid sinus syndrome in the elderly. Am J Med. 1993;95:203–208[CrossRef][ISI][Medline]
  73. Graux P, Mekerke W, Lemaire N. Le syndrome du sinus carotidien. Apport de la monitorisation de la pression arterielle a l'exploration electrophysiologique endocavitaire. Arch Mal Coeur. 1989;82:193–199
  74. Huang SKS, Ezri MD, Honser RG, Denes P. Carotid sinus hypersensitivity in patients with unexplained syncope: clinical, electrophysiologic, and long-term follow-up observation. Am Heart J. 1988;116:989–996[CrossRef][ISI][Medline]
  75. Volkmann H, Schnerch B, Kuhnert H. Diagnostic value of carotid sinus hypersensitivity. PACE. 1990;13:2065–2070
  76. Brignole M, Gigli G, Altomonte F. The cardioinhibitory reflex evoked by carotid sinus stimulation in normal and in patients with cardiovascular disorders. G Ital Cardiol. 1985;15:514–519[Medline]
  77. Brown KA, Maloney JA, Smith HC. Carotid sinus reflex in patients undergoing coronary angiography: relationship of degree and location of coronary artery disease to response to carotid sinus massage. Circulation. 1980;62:697–703[Abstract/Free Full Text]
  78. Brignole M, Sartore B, Prato R. Role of body position during carotid sinus stimulation test in the diagnosis of cardioinhibitory carotid sinus syndrome. G Ital Cardiol. 1983;14:69–72
  79. Parry SW, Richardson D, O'Shea D, Sen B, Kenny RA. Diagnosis of carotid sinus hypersensitivity in older adults: carotid sinus massage in the upright position is essential. Heart. 2000;83:22–23[Abstract/Free Full Text]
  80. Thomas JE. Hyperactive carotid sinus reflex and carotid sinus syncope. Mayo Clin Proc. 1969;44:127–139[ISI][Medline]
  81. Brignole M, Menozzi C, Lolli G, Bottoni N, Gaggioli G. Long-term outcome of paced and non paced patients with severe carotid sinus syndrome. Am J Cardiol. 1992;69:1039–1043[CrossRef][ISI][Medline]
  82. Brignole M, Menozzi C. Carotid sinus syndrome: diagnosis natural history and treatment. Eur J Cardiac Pacing Electrophysiol. 1992;4:247–254
  83. Brignole M, Menozzi C, Gianfranchi L, Oddone D, Lolli G, Bertulla A. Carotid sinus massage, eyeball compression and head-up tilt test in patients with syncope of uncertain origin and in healthy control subjects. Am Heart J. 1991;122:1644–1651[CrossRef][ISI][Medline]
  84. Brignole M, Menozzi C, Gianfranchi L, Oddone D, Lolli G, Bertulla A. Neurally mediated syncope detected by carotid sinus massage and head-up tilt test in sick sinus syndrome. Am J Cardiol. 1991;68:1032–1036[CrossRef][ISI][Medline]
  85. Gaggioli G, Brignole M, Menozzi C. Reappraisal of the vasodepressor reflex in carotid sinus syndrome. Am J Cardiol. 1995;75:518–521[CrossRef][ISI][Medline]
  86. Munro N, McIntosh S, Lawson J, Morley CA, Sutton R, Kenny RA. The incidence of complications after carotid sinus massage in older patients with syncope. J Am Geriatr Soc. 1994;42:1248–1251[ISI][Medline]
  87. Davies AG, Kenny RA. Neurological complications following carotid sinus massage. Am J Cardiol. 1998;81:1256–1257[CrossRef][ISI][Medline]
  88. Voss DM, Magnin GE. Demand pacing and carotid sinus syncope. Am Heart J. 1970;79:544–547[CrossRef][ISI][Medline]
  89. Peretz DP, Gerein AN, Miyagishima RT. Permanent demand pacing for hypersensitive carotid sinus syndrome. Can Med Assoc J. 1973;108:1131–1134[Medline]
  90. Von Maur K, Nelson EW, Holsinger JW, Eliot RS. Hypersensitive carotid sinus syncope treated by implantable demand cardiac pacemaker. Am J Cardiol. 1972;29:109–110[CrossRef][ISI][Medline]
  91. Morley CA, Perrins EJ, Grant PL, Chan SL, McBrien DJ, Sutton R. Carotid sinus syncope treated by pacing. Analysis of persistent symptoms and role of atrio ventricular sequential pacing. Br Heart J. 1982;47:411–418[Abstract/Free Full Text]
  92. Blanc JJ, Boschat J, Penther Ph. Hypersensibilité sino-carotidienne. Evolution à moyen terme en fonction du traitement et de ses symptômes. Arch Mal Coer. 1984;77:330–336
  93. Menozzi C, Brignole M, Lolli G. Follow-up of asystolic episodes in patients with cardioinhibitory, neurally mediated syncope and VVI pacemaker. Am J Cardiol. 1993;72:1152–1155[CrossRef][ISI][Medline]
  94. Van Lieshout JJ, Wieling W, Karemaker JM, Eckberg D. The vasovagal response. Clin Sci. 1991;81:575–586[Medline]
  95. Rea RF, Thames MD. Neural control mechanisms and vasovagal syncope. J Cardiovasc Electrophysiol. 1993;4:587–595[ISI][Medline]
  96. Robertson RM, Medina E, Shah N, Furlan R, Mosqueda-Garcia R. Neurally mediated syncope: pathophysiology and implications for treatment. Am J Med Sci. 1999;317:102–109[CrossRef][ISI][Medline]
  97. Schondorf R, Wieling W. Vasoconstrictor reserve in neurally mediated syncope. Clin Autonom Res. 2000;10:53–56[CrossRef][ISI][Medline]
  98. Kenny RA, Ingram A, Bayliss J, Sutton R. Head-up tilt: a useful test for investigating unexplained syncope. Lancet. 1986 Jun 14;1:1352–1355
  99. Fitzpatrick AP, Theodorakis G, Vardas P, Sutton R. Methodology of head-up tilt testing in patients with unexplained syncope. J Am Coll Cardiol. 1991;17:125–130[Abstract]
  100. Almquist A, Goldenberg IF, Milstein S. Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope. N Engl J Med. 1989;320:346–351[Abstract]
  101. Waxman MB, Yao L, Cameron DA, Wald RW, Roseman J. Isoproterenol induction of vasodepressor-type reaction in vasodepressor-prone persons. Am J Cardiol. 1989;63:58–65[CrossRef][ISI][Medline]
  102. Kapoor WN, Brant N. Evaluation of syncope by upright tilt testing with isoproterenol. A nonspecific test. Ann Intern Med. 1992;116:358–363[ISI][Medline]
  103. Morillo CA, Klein GJ, Zandri S, Yee R. Diagnostic accuracy of a low-dose isoproterenol head-up tilt protocol. Am Heart J. 1995 May;129:901–906[CrossRef][ISI][Medline]
  104. Natale A, Aktar M, Jazayeri M. Provocation of hypotension during head-up tilt testing in subjects with no history of syncope or presyncope. Circulation. 1995;92:54–58[Abstract/Free Full Text]
  105. Raviele A, Gasparini G, Di Pede F. Nitroglycerin infusion during upright tilt: a new test for the diagnosis of vasovagal syncope. Am Heart J. 1994;127:103–111[CrossRef][ISI][Medline]
  106. Raviele SA, Menozzi C, Brignole M. Value of head-up tilt testing potentiated with sublingual nitroglycerin to assess the origin of unexplained syncope. Am J Cardiol. 1995;76:267–272[CrossRef][ISI][Medline]
  107. Oraii S, Maleki M, Minooii M, Kafai I. Comparing two different protocols for tilt table testing: sublingual glyceryl trinitrate versus isoprenaline infusions. Heart. 1999;81:603–605[Abstract/Free Full Text]
  108. Raviele A, Giada F, Brignole M. Diagnostic accuracy of sublingual nitroglycerin test and low-dose isoproterenol test in patients with unexplained syncope. A comparative study. Am J Cardiol. 2000;85:1194–1198[CrossRef][ISI][Medline]
  109. Bartoletti A, Gaggioli G, Bottoni N. Head-up tilt testing potentiated with oral nitroglycerin. A randomized trial of the contribution of a drug-free phase and a nitroglycerin phase in the diagnosis of neurally mediated syncope. Europace. 1999;1:183–186[Abstract/Free Full Text]
  110. Del Rosso A, Bartoli P, Bartoletti A. Shortened head-up tilt testing potentiated with sublingual nitroglycerin in patients with unexplained syncope. Am Heart J. 1998;135:564–570[CrossRef][ISI][Medline]
  111. Natale A, Sra J, Akhtar M. Use of sublingual nitroglycerin in patients with unexplained syncope. Am Heart J. 1998;135:564–570[CrossRef][ISI][Medline]
  112. Del Rosso A, Bartoletti A, Bartoli P. Methodology of head-up tilt testing potentiated with sublingual nitroglycerin in unexplained syncope. Am J Cardiol. 2000;85:1007–1011[CrossRef][ISI][Medline]
  113. Foglia Manzillo G, Giada F, Beretta S, Corrado G, Santarone M, Raviele A. Reproducibility of head-up tilt testing potentiated with sublingual nitroglycerin in patients with unexplained syncope. Am J Cardiol. 1999;84:284–288[CrossRef][ISI][Medline]
  114. Zeng C, Zhu Z, Hu W, Liu G, Zhu S, Zhou Y, Shi W. Value of sublingual isosorbide dinitrate before isoproterenol tilt test for diagnosis of neurally mediated syncope. Am J Cardiol. 1999;83:1059–1063[CrossRef][ISI][Medline]
  115. Ammirati F, Colivicchi F, Biffi A, Magris B, Pandozi C, Santini M. Head-up tilt testing potentiated with low-dose sublingual isosorbide dinitratte: A simplified time-saving approach for the evaluation of unexplained syncope. Am Heart J. 1998;135:671–676[CrossRef][ISI][Medline]
  116. Voice RA, Lurie KG, Sakaguchi S, Rector TS, Benditt DG. Comparison of tilt angles and provocative agents (edrophonium and isoproterenol) to improve head-upright tilt-table testing. Am J Cardiol. 1998;81:346–351[CrossRef][ISI][Medline]
  117. Fitzpatrick AP, Lee RJ, Epstein LM, Lesh MD, Eisenberg S, Sheinman MM. Effect of patient characteristics on the yield of prolonged baseline head-up tilt testing and the additional yield of drug provocation. Heart. 1996;76:406–411[Abstract/Free Full Text]
  118. Theodorakis G, Markianos M, Zarvalis E. Provocation of neurocardiogenic syncope by clomipramine administration during the head-up tilt test in vasovagal syncope. J Am Coll Cardiol. 2000;36:174–178[Abstract/Free Full Text]
  119. Benditt DG, Ferguson DW, Grubb BP. Tilt table testing for assessing syncope. ACC expert consensus document. J Am Coll Cardiol. 1996;28:263–275[CrossRef][ISI][Medline]
  120. McIntosh SJ, Lawson J, Kenny RA. Intravenous cannulation alters the specificity of head-up tilt testing for vasovagal syncope in elderly patients. Age Ageing. 1994;63:58–65
  121. De Jong-de Vos van Steenwijk CCE, Wieling W, Johannes JM, Harms MPM, Kuis W, Wesseling KH. Incidence and hemodynamics of near-fainting in healthy 6–16 year old subjects. J Am Coll Cardiol. 1995;25:1615–1621[Abstract]
  122. Imholz BPM, Wieling W, van Montfrans GA, Wesseling KH. Fifteen-years-experience with finger arterial pressure monitoring: Assessment of the technology. Cardiovasc Res. 1998;38:605–616[Abstract/Free Full Text]
  123. Sutton R, Petersen M, Brignole M, Raviele A, Menozzi C, Giani P. Proposed classification for tilt induced vasovagal syncope. Eur J Cardiac Pacing Electrophysiol. 1992;3:118–180
  124. Brignole M, Menozzi C, Del Rosso A. New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification. Analysis of the pre-syncopal phase of the tilt test without and with nitroglycerin challenge. Europace. 2000;2:66–76[Abstract/Free Full Text]
  125. Wieling W, van Lieshout JJ, ten Harkel ADJ. Dynamics of circulatory adjustments to head up tilt and tilt back in healthy and sympathetically denervated subjects. Clin Sci. 1998;94:347–352[Medline]
  126. Grubb BP, Karas B. Diagnosis and management of neurocardiogenic syncope. Curr Opinion Cardiol. 1998;13:29–35[ISI][Medline]
  127. Sheldon R, Splawinski J, Killam S. Reproducibility of isoproterenol tilt-table tests in patients with syncope. Am J Cardiol. 1992 May 15;69:1300–1305
  128. Grubb BP, Wolfe D, Tenesy Armos P, Hahn H, Elliot L. Reproducibility of head upright tilt-table test in patients with syncope. PACE. 1992;15:1477–1481
  129. De Buitler M, Grogan EW Jr, Picone MF, Casteen JA. Immediate reproducibility of the tilt table test in adults with unexplained syncope. Am J Cardiol. 1993;71:304–307[CrossRef][ISI][Medline]
  130. Brooks R, Ruskin JN, Powell AC, Newell J, Garan H, McGovern BA. Prospective evaluation of day-to-day reproducibility of upright tilt-table testing in unexplained syncope. Am J Cardiol. 1993;71:1289–1292[CrossRef][ISI][Medline]
  131. Blanc JJ, Mansourati J, Maheu B, Boughaleb D, Genet L. Reproducibility of a positive passive upright tilt test at a seven-day interval in patients with syncope. Am J Cardiol. 1993;15:469–471[CrossRef]
  132. Moya A, Permanyer-Miralda G, Sagrista-Sauleda J. Limitations of head-up tilt test for evaluating the efficacy of therapeutic interventions in patients with vasovagal syncope: results of a controlled study of etilefrine versus placebo. J Am Coll Cardiol. 1995;25:65–69[Abstract]
  133. Morillo CA, Leitch JW, Yee R, Klein GL. A placebo-controlled trial of intravenous and oral disopyramide for prevention of neurally mediated syncope induced by head-up tilt. J Am Coll Cardiol. 1993;22:1843–1848[Abstract]
  134. Raviele A, Brignole M, Sutton R. Effect of etilefrine in preventing syncopal recurrence in patients with vasovagal syncope: a double-blind, randomized, placebo-controlled trial. The Vasovagal Syncope International Study. Circulation. 1999;99:1452–1457[Abstract/Free Full Text]
  135. Sutton R, Brignole M, Menozzi C. Dual-chamber pacing in treatment of neurally-mediated tilt-positive cardioinhibitory syncope. Pacemaker versus no therapy: a multicentre randomized study. Circulation. 2000;102:294–299[Abstract/Free Full Text]
  136. Maloney J, Jaeger F, Fouad-Tarazi F, Morris H. Malignant vasovagal syncope: prolonged asystole provoked by head-up tilt. Cliv Clin J Med. 1988;55:542–548
  137. Leman RB, Clarke E, Gillette P. Significant complications can occur with ischemic heart disease and tilt table testing. PACE. 1999;22:675–677
  138. Gatzoulis KA, Mamarelis IE, Apostolopoulos T, Dilaveris P, Gialafos J, Toutouzas. Polymorphic ventricular tachycardia induced during tilt table testing in a patient with syncope and probable dysfunction of the sinus node. PACE. 1995;18:1075–1079
  139. Leitch, J, Klein, G, Yee, R, Murdick, C, Teo, WS, Neurally-mediated syncope and atrial fibrillation, N Engl J Med, 1991, 324, 495, 6, (letter) dysfunction of the sinus node, PACE, 1995, 18, 1075, 9
  140. Kapoor WN. Evaluation and management of the patient with syncope. JAMA. 1992;268:2553–2560[Abstract]
  141. Gibson TC, Heitzman MR. Diagnostic efficacy of 24-hour electrocardiographic monitoring for syncope. Am J Cardiol. 1984;53:1013–1017[CrossRef][ISI][Medline]
  142. DiMarco JP, Philbrick JT. Use of electrocardiographic (Holter) monitoring. Ann Intern Med. 1990;113:53–68[ISI][Medline]
  143. Bass EB, Curtiss EJ, Arena VC. The duration of Holter monitoring in patients with syncope: is 24 hours enough? Arch Intern Med. 1990;150:1073–1078[Abstract]
  144. Linzer M, Pritchett ELC, Pontinen M, McCarthy E, Divine GW. Incremental diagnostic yield of loop electrocardiographic recorders in unexplained syncope. Am J Cardiol. 1990;66:214–219[CrossRef][ISI][Medline]
  145. Krahn A, Klein GJ, Yee R, Norris C. Final results from a pilot study with an implantable loop recorder to determine the etiology of syncope in patients with negative noninvasive and invasive testing. Am J Cardiol. 1998;82:117–119[CrossRef][ISI][Medline]
  146. Krahn AD, Klein GJ, Yee R, Takle-Newhouse T, Norris C. Use of an extended monitoring strategy in patients with problematic syncope. Circulation. 1999;26:406–410
  147. Zaidi A, Fitzpatrick AP. Single centre experience of 64 Insertable Loop Recorders for investigation of unexplained syncope (Abstr). PACE. 1999;22:756
  148. Brignole M, Menozzi C, Bottoni N. Mechanisms of syncope caused by transient bradycardia and the diagnostic value of electrophysiologic testing and cardiovascular reflexivity maneuvers. Am J Cardiol. 1995;76:273–278[CrossRef][ISI][Medline]
  149. Santini M, Ansalone G, Cacciatore G, Turitto G. Transesophageal pacing. PACE. 1990;13:1298–1323
  150. Nanthakumar K, Bergfeldt L, Darpö B. Assessment of accessory pathway and atrial refractoriness by transesophageal and intracardiac atrial stimulation. An analysis of methodological agreement. Europace. 1999;1:55–62[Abstract/Free Full Text]
  151. Fujimura O, Yee R, Klein G, Sharma A, Boahene A. The diagnostic sensitivity of electrophysiologic testing in patients with syncope caused by transient bradycardia. N Engl J Med. 1989;321:1703–1707[Abstract]
  152. Lacroix D, Dubuc M, Kus T, Savard P, Shenasa M, Nadeau R. Evaluation of arrhythmic causes of syncope: correlation between Holter monitoring, electrophysiologic testing, and body surface potential mapping. Am Heart J. 1991;122:1346–1354[CrossRef][ISI][Medline]
  153. Moazez F, Peter T, Simonson J, Mandel W, Vaughn C, Gang E. Syncope of unknown origin: clinical, noninvasive, and electrophysiologic determinants of arrhythmia induction and symptom recurrence during long-term follow-up. Am Heart J. 1991;121:81–88[CrossRef][ISI][Medline]
  154. Bergfeldt L, Vallin H, Rosenqvist M, Insulander P, ström H, Nordlander R. Sinus node recovery time assessment revisited: role of pharmacological blockade of the autonomic nervous system. J Cardiovasc Electrophysiol. 1996;7:95–101[ISI][Medline]
  155. Englund A, Bergfeldt L, Rosenqvist M. Pharmacological stress testing of the His-Purkinje system in patients with bifascicular block. PACE. 1998;21:1979–1987
  156. Linzer M, Yang E, Estes M, Wang P, Vorperian V, Kapoor W. Diagnosing syncope. Part II: Unexplained syncope. Ann Intern Med. 1997;127:76–86[Abstract/Free Full Text]
  157. Bergfeldt L, Rosenqvist M, Vallin H, Nordlander R, ström H. Screening for sinus node dysfunction by analysis of short-term sinus cycle variations on the surface electrocardiogram. Am Heart J. 1995;130:141–147[CrossRef][ISI][Medline]
  158. Benditt DG, Gornick C, Dunbar D, Almquist A, Pool-Scheider S. Indications for electrophysiological testing in diagnosis and assessment of sinus node dysfunction. Circulation. 1987;75:93–99
  159. Freedman RA. Sinus node dysfunction. Cardiac Electrophysiol Rev. 1999;3:74–79[CrossRef]
  160. Alboni P, Filippi L, Pirani R, Tomasi AM, Candini GC, Masoni A. Reproducibility of electrophysiological parameters of sinus node following autonomic blockade. Int J Cardiol. 1983;4:431–442[CrossRef][ISI][Medline]
  161. Narula O, Samet P, Javier RP. Significance of the sinus node recovery time. Circulation. 1972;45:55–61[Abstract/Free Full Text]
  162. Vallin H, Edhag O, Sowton E. Diagnostic capacity of sinus node recovery time after inhibition of autonomous neural tone. Eur J Cardiol. 1980;12:81–93[ISI][Medline]
  163. Jose AD, Collison D. The normal range and determinants of the intrinsic heart rate in man. Cardiovasc Res. 1970;4:160–166[Abstract/Free Full Text]
  164. Jordan JL, Yamaguchi I, Mandel WJL. Studies on the mechanism of sinus node dysfunction in the sick sinus syndrome. Circulation. 1978;57:217–223[Abstract/Free Full Text]
  165. Alboni P, Malacarne C, Pedroni P, Masoni A, Narula OS. Electrophysiology of normal sinus node with and without autonomic blockade. Circulation. 1982;65:1236–1242[Free Full Text]
  166. Tonkin AM, Heddle WF. Electrophysiological testing of sinus node function. PACE. 1984;7:735–748
  167. Gann D, Tolentino A, Samet P. Electrophysiologic evaluation of elderly patients with sinus bradycardia. A long-term follow-up study. Ann Intern Med. 1979;90:24–29[ISI][Medline]
  168. Menozzi C, Brignole M, Alboni P. The natural course of untreated sick sinus syndrome and identification of the variables predictive of unfavourable outcome. Am J Cardiol. 1998;82:1205–1209[CrossRef][ISI][Medline]
  169. Dhingra R. Sinus node dysfunction. PACE. 1983;6:1062–1069
  170. Rosenbaum MB, Elizari MV, Lazzari JO. Los hemibloqueos. Buenos Aires: Parados; 1968.
  171. Demoulin JC, Kulbertus HE. Histopathological examination of concept of left hemiblock. Br Heart J. 1972;34:807–814[Free Full Text]
  172. Dhala A, Gonzalez-Zuelgaray J, Deshpande S. Unmasking the trifascicular left intraventricular conduction system by ablation of the right bundle branch. Am J Cardiol. 1996;77:706–712[CrossRef][ISI][Medline]
  173. Bergfeldt L, Edvardsson N, Rosenqvist M, Vallin H, Edhag O. Atrioventricular block progression in patients with bifascicular block assessed by repeated electrocardiography and a bradycardia-detecting pacemaker. Am J Cardiol. 1994;74:1129–1132[CrossRef][ISI][Medline]
  174. McAnulty JH, Rahimtoola SH, Murphy E. Natural history of ‘high risk’ bundle branch block. Final report of a prospective study. N Engl J Med. 1982;307:137–143[Abstract]
  175. Scheinman MM, Peters RW, Sauvé MJ. Value of the H-Q interval in patients with bundle branch block and the role of prophylactic permanent pacing. Am J Cardiol. 1982;50:1316–1322[CrossRef][ISI][Medline]
  176. Rosen KM, Rahimtoola SH, Chquimia R, Loeb HS, Gunnar RM. Electrophysiological significance of first-degree atrioventricular block with intraventricular conduction disturbance. Circulation. 1971;43:491–502[Abstract/Free Full Text]
  177. Dhingra RC, Wyndham C, Bauernfeind R. Significance of block distal to the His bundle induced by atrial pacing in patients with chronic bifascicular block. Circulation. 1979;60:1455–1464[Abstract/Free Full Text]
  178. Petrac D, Radic B, Birtic K, Gjurovic J. Prospective evaluation of infrahisal second-degree AV block induced by atrial pacing in the presence of chronic bundle branch block and syncope. PACE Pacing Clin Electrophysiol. 1996;19:679–687
  179. Click R, Gersh B, Sugrue D. Role of invasive electrophysiologic testing in patients with symptomatic bundle branch block. Am J Cardiol. 1987;59:817–823[CrossRef][ISI][Medline]
  180. Gronda M, Magnani A, Occhetta E. Electrophysiologic study of atrio-ventricular block and ventricular conduction defects. G Ital Cardiol. 1984;14:768–773[Medline]
  181. Dini P, Iaolongo D, Adinolfi E. Prognostic value of His-ventricular conduction after ajmaline administration. Masoni A, Alboni P. Cardiac Electrophysiology Today. London: Academic Press; 1982. p. 515–522
  182. Kaul U, Dev V, Narula J, Malhotra A, Talwar K, Bhatia M. Evaluation of patients with bundle branch block and ‘unexplained’ syncope: a study based on comprehensive electrophysiologic testing and ajmaline stress. PACE. 1988;11:289–297
  183. Twidale N, Heddle W, Tonkin A. Procainamide administration during electrophysiologic study—utility as a provocative test for intermittent atrioventricular block. PACE. 1988;11:1388–1397
  184. Link M, Kim KM, Homoud M, Estes M III, Wang P. Long-term outcome of patients with syncope associated with coronary artery disease and a non diagnostic electrophysiological evaluation. Am J Cardiol. 1999;83:1334–1337[CrossRef][ISI][Medline]
  185. Gaggioli G, Bottoni N, Brignole M. Progression to second or third-degree atrioventricular block in patients electrostimulated for bundle branch block: a long-term study. G Ital Cardiol. 1994;24:409–416[Medline]
  186. Dhingra RC, Palileo E, Strasberg B. Significance of the HV interval in 517 patients with chronic bifascicular block. Circulation. 1981;64:1265–1271[Abstract/Free Full Text]
  187. Englund A, Bergfeldt L, Rehnqvist N, ström H, Rosenqvist M. Diagnostic value of programmed ventricular stimulation in patients with bifascicular block: a prospective study of patients with and without syncope. J Am Coll Cardiol. 1995;26:1508–1515[Abstract]
  188. Morady F, Higgins J, Peters R. Electrophysiologic testing in bundle branch block and unexplained syncope. Am J Cardiol. 1984;54:587–591[CrossRef][ISI][Medline]
  189. Goldreyer BN, Kastor JA, Kershbaum KL. The hemodynamic effects of induced supraventricular tachycardia in man. Circulation. 1976;54:783–789[Abstract/Free Full Text]
  190. Bigger JT Jr, Reiffel JA, Livelli FD, Wang PJ. Sensitivity, specificity, and reproducibility of programmed ventricular stimulation. Circulation. 1986;73:73–78[Abstract/Free Full Text]
  191. Wellens HJJ, Brugada P, Stevenson WG. Programmed electrical stimulation of the heart in patients with life-threatening ventricular arrhythmias: what is the significance of induced arrhythmias and what is the correct stimulation protocol? Circulation. 1986;72:1–7
  192. Olshansky B, Hahn EA, Hartz VL, Prater SP, Mason JW. Clinical significance of syncope in the electrophysiologic study versus electrocardiographic monitoring (ESVEM) trial. Am Heart J. 1999;137:878–886[CrossRef][ISI][Medline]
  193. Alings M, Wilde A. ‘Brugada’ syndrome. Clinical data and suggested pathophysiological mechanism. Circulation. 1999;99:666–673[Free Full Text]
  194. Brugada J, Brugada P, Brugada R. The syndrome of right bundle branch block ST segment elevation in V1 to V3 and sudden death—the Brugada syndrome. Europace. 1999;1:156–166[Abstract/Free Full Text]
  195. Kelly P, Ruskin JN, Vlahakes GJ, Buckley MJ Jr, Freeman CS, Garan H. Surgical coronary revascularization in survivors of prehospital cardiac arrest: its effect on inducible ventricular arrhythmias and long-term survival. J Am Coll Cardiol. 1990;15:267–273[Abstract]
  196. Bergfeldt L. CABG and ICD for all patients with hemodynamically significant ventricular arrhythmia and significant coronary artery disease? Do we know enough to decide—or to design a randomized trial. PACE. 1999;22:1129–1131
  197. Knight B, Goyal R, Pelosi F. Outcome of patients with nonischemic dilated cardiomyopathy and unexplained syncope treated with an implantable defibrillator. J Am Coll Cardiol. 1999;33:1964–1970[Abstract/Free Full Text]
  198. Link MS, Costeas XF, Griffith JL. High incidence of appropriate implantable cardioverter-defibrillator therapy in patients with syncope of unknown etiology and inducible ventricular tachycardia. J Am Coll Cardiol. 1997;29:370–375[Abstract]
  199. Militianu A, Salacata A, Seibert K. Implantable cardioverter defibrillator utilization among device recipients presenting exclusively with syncope or near-syncope. J Cardiovasc Electrophysiol. 1997;8:1087–1097[ISI][Medline]
  200. Mittal S, Iwai S, Stein K, Markowitz S, Slotwiner D, Lerman B. Long-term outcome of patients with unexplained syncope treated with an electrophysiologic-guided approach in the implantable cardioverter-defibrillator era. J Am Coll Cardiol. 1999;34:1082–1089[Abstract/Free Full Text]
  201. Andrews N, Fogel R, Pelargonio G, Evans J, Prystowsky E. Implantable defibrillator event rates in patients with unexplained syncope and inducible sustained ventricular tachyarrhythmias. J Am Coll Cardiol. 1999;34:2023–2030[Abstract/Free Full Text]
  202. Pires L, May L, Ravi S, Parry T, Lal V, Nino C. Comparison of event rates and survival in patients with unexplained syncope without documented ventricular tachyarrhythmias versus patients with documented sustained ventricular tachyarrhythmias both treated with implantable cardioverter-defibrillator. Am J Cardiol. 2000;85:725–728[CrossRef][ISI][Medline]
  203. Fonarow G, Feliciano Z, Boyle N. Improved survival in patients with nonischemic advanced heart failure and syncope treated with an implantable cardioverter-defibrillator. Am J Cardiol. 2000;85:981–985[CrossRef][ISI][Medline]
  204. Flammang D, Church T, Waynberger M, Chassing A, Antiel M. Can adenosine 5' triphosphate be used to select treatment in severe vasovagal syndrome? Circulation. 1997;96:1201–1208[Abstract/Free Full Text]
  205. Brignole M, Gaggioli G, Menozzi C. Adenosine-induced atrioventricular block in patients with unexplained syncope. The diagnostic value of ATP test. Circulation. 1997;96:3921–3927[Abstract/Free Full Text]
  206. Belardinelli L, Linden J, Berne RM. The cardiac effects of Adenosine. Prog Cardiovasc Dis. 1989;22:73–97
  207. Flammang D, Chassing A, Donal E, Hamani D, Erickson M, McCarville S. Reproducibility of the 5' triphosphate test in vasovagal syndrome. J Cardiovasc Electrophysiol. 1998;9:1161–1166[ISI][Medline]
  208. Flammang D, Erickson M, McCarville S, Church T, Hamani D, Donal E. Contribution of head-up tilt testing and ATP testing in assessing the mechanisms of vaso vagal syndrome. Preliminary results and potential therapeutic implications. Circulation. 1999;99:2427–2433[Abstract/Free Full Text]
  209. Brignole M, Gaggioli G, Menozzi C. Clinical features of Adenosine sensitive syncope and Tilt-induced vasovagal syncope. Heart. 2000;83:24–28[Abstract/Free Full Text]
  210. Shen WK, Hammil S, Munger T. Adenosine: potential modulator for vasovagal syncope. J Am Coll Cardiol. 1996;28:146–154[Abstract]
  211. Mittal S, Stein K, Markowitz S, Slotwiner D, Rohatgi S, Lerman B. Induction of neurally mediated syncope with Adenosine. Circulation. 1999;99:1318–1324[Abstract/Free Full Text]
  212. Berbari EJ, Scherlag BJ, Hope RR, Lazzara R. Recording from the body surface of arrhythmogenic ventricular activity during the S-T segment. Am J Cardiol. 1978;41:697–702[CrossRef][ISI][Medline]
  213. Kuchar DL, Thorburn CW, Sammel NL. Signal averaged electrocardiogram for evaluation of recurrent syncope. Am J Cardiol. 1986;58:949–953[CrossRef][ISI][Medline]
  214. Gang ES, Peter T, Rosenthal ME, Mandel WJ, Lass Z. Detection of late potentials on the Surface electrocardiogram in unexplained syncope. Am J Cardiol. 1986;58:1014–1020[CrossRef][ISI][Medline]
  215. Winters SL, Steward D, Gomes JA. Signal averaging of the surface QRS complex predicts inducibility of ventricular tachycardia in patients with syncope of unknown origin: a prospective study. J Am Coll Cardiol. 1987;10:775–781[Abstract]
  216. Steinberg JS, Prystowsky E, Freedman RA. Use of the signal-averaged electrocardiogram for predicting inducible ventricular tachycardia in patients with unexplained syncope: relation to clinical variables in a multivariate analysis. J Am Coll Cardiol. 1994;23:99–106[Abstract]
  217. Leclercq JF, Coumel P. Late potentials in arrhythmogenic right ventricular dysplasia. Prevalence, diagnostic and prognostic values. Eur Heart J. 1993;14:80–83
  218. Keeling PJ, Kulakowski P, Gang Z, Slade AKB, Bent S, McKenna WJ. Usefulness of signal-averaged electrocardiogram in idiopathic dilated cardiomyopathy for identifying patients with ventricular arrhythmias. Am J Cardiol. 1993;72:78–84[CrossRef][ISI][Medline]
  219. Dubrey SW, Bilazarian S, LaValley M, Reisinger J, Skinner M, Falk RH. Signal-averaged electrocardiography in patients with AL (primary) amyloidosis. Am Heart J. 1997;134:994–1001[CrossRef][ISI][Medline]
  220. Moser D, Stevenson WG, Woo MA. Frequency of late potentials in systemic sclerosis. Am J Cardiol. 1991;67:541–543[CrossRef][ISI][Medline]
  221. Baciarello G, Villani M, Di Maio F, Sciacca A. Late surface potentials in myotonic dystrophy with ventricular tachycardia. Am Heart J. 1986;111:413–414[CrossRef][ISI][Medline]
  222. Mehta D, McKenna WJ, Ward DE, Davies MJ, Camm AJ. Significance of signal-averaged electrocardiography in relation to endomyocardial biopsy and ventricular stimulation studies in patients with ventricular tachycardia without clinically apparent heart disease. J Am Coll Cardiol. 1989;14:372–379[Abstract]
  223. Breithardt G, Cain ME, El-Sherif N. Standards for analysis of ventricular late potentials using high resolution or signal-averaged electrocardiography. A statement by a Task Force Committee between the European Society of Cardiology, the American Heart Association and the American College of Cardiology. Eur Heart J. 1991;12:473–480[Abstract/Free Full Text]
  224. Yerg JE 2nd, Seals DR, Hagberg JM, Ehsani AA. Syncope secondary to ventricular asystole in an endurance athlete. Clin Cardiol. 1986;9:220–222[ISI][Medline]
  225. Huycke EC, Card HG, Sobol SM, Nguyen NX, Sung RJ. Postexertional cardiac asystole in a young man without organic heart disease. Ann Intern Med. 1987;106:844–845[ISI][Medline]
  226. Greci ED, Ramsdale DR. Exertional syncope in aortic stenosis: evidence to support inappropriate left ventricular baroreceptor response. Am Heart J. 1991;121:603–606[CrossRef][ISI][Medline]
  227. Arad M, Solomon A, Roth A, Atsmon J, Rabinowitz B. Postexercise syncope: evidence for increased activity of the sympathetic nervous system. Cardiology. 1993;83:121–123[ISI][Medline]
  228. Osswald S, Brooks R, O'Nunain SS. Asystole after exercise in healthy persons. Ann Intern Med. 1994;120:1008–1011[Free Full Text]
  229. Sneddon JF, Scalia G, Ward DE, McKenna WJ, Camm AJ, Frenneaux MP. Exercise induced vasodepressor syncope. Br Heart J. 1994;71:554–557[Abstract/Free Full Text]
  230. Sakaguchi S, Shultz JJ, Remole SC, Adler SW, Lurie KG, Benditt DG. Syncope associated with exercise, a manifestation of neurally mediated syncope. Am J Cardiol. 1995;75:476–481[CrossRef][ISI][Medline]
  231. Calkins H, Seifert M, Morady F. Clinical presentation and long-term follow-up of athletes with exercise-induced vasodepressor syncope. Am Heart J. 1995;129:1159–1164[CrossRef][ISI][Medline]
  232. Tse HF, Lau P. Exercise-associated cardiac asystole in persons without structural heart disease. Chest. 1995;107:572–576[Abstract/Free Full Text]
  233. Thomson HL, Atherton JJ, Khafagi FA, Frenneaux MP. Failure to reflex venoconstriction during exercise in patients with vasovagal syncope. Circulation. 1996;93:953–959[Abstract/Free Full Text]
  234. Shapira Y, Kusniec J, Birnbaum Y, Strasberg B. Exercise-induced syncope and Holter-documented asystole in an endurance runner with moderate aortic stenosis. Clin Cardiol. 1996;19:71–73[ISI][Medline]
  235. Kosinski D, Grubb BP, Kip K, Hahn H. Exercise-induced neurocardiogenic syncope. Am Heart J. 1996;132:451–452[CrossRef][ISI][Medline]
  236. Smith GPD, Mathias CJ. Postural hypotension enhanced by exercise in patients with chronic autonomic failure. Q J Med. 1995;88:251–256
  237. Byrne JM, Marais HJ, Cheek GA. Exercise-induced complete heart block in a patient with chronic bifascicular block. J Electrocardiol. 1994;27:339–342[CrossRef][ISI][Medline]
  238. Woeifel AK, Simpson RJ, Gettes LS, Foster JR. Exercise-induced distal atrio-ventricular block. J Am Coll Cardiol. 1983;2:578–582[Abstract]
  239. Barra M, Brignole M, Menozzi C, Sartore B, De Marchi E, Bertulla A. Exercise induced intermittent atrio-ventricular block. Three cases report. G Ital Cardiol. 1985;15:1051–1055[Medline]
  240. Kovac JD, Murgatroyd FD, Skehan JD. Recurrent syncope due to complete atrioventricular block, a rare presenting symptom of otherwise silent coronary artery disease: successful treatment by PTCA. Cathet Cardiovasc Diagn. 1997;42:216–218[CrossRef][ISI][Medline]
  241. Ascheim DD, Markowitz SM, Lai H, Engelstein ED, Stein KM, Lerman BB. Vasodepressor syncope due to subclinical myocardial ischemia. J Cardiovasc Electrophysiol. 1997;8:215–221[ISI][Medline]
  242. Havranek EP, Dunbar DN. Exertional syncope caused by left main coronary artery spasm. Am Heart J. 1992;123:792–794[CrossRef][ISI][Medline]
  243. Hattori R, Murohara Y, Yui Y, Takatsu Y, Kawai C. Diffuse triple-vessel coronary artery spasm complicated by idioventricular rhythm and syncope. Chest. 1987;92:183–185[Abstract/Free Full Text]
  244. Watanabe K, Inomata T, Miyakita Y. Electrophysiologic study and ergonovine provocation of coronary spasm in unexplained syncope. Jpn Heart J. 1993;34