A simple score derived from clinical history can be usefully employed for the triage and management of patients with syncope in an ED.

A standardized-care pathway significantly improved diagnostic yield and reduced hospital admissions, resource consumption, and overall costs.

Background and Purpose-In patients with atrial fibrillation (AF), stroke risk stratification schema do not consider AF parameters. The aim of the study is to assess the impact of combining risk factors with continuous AF burden monitoring. Methods-In this retrospective study 568 patients implanted with a DDDR-P pacemaker (AT-500; Medtronic) and a history of AF were continuously monitored for 1 year. Results-During follow-up, 14 patients (2.5%) had a thromboembolic event. Patients were divided into 3 groups: AF burden Յ5 minutes per day (AF-free; nϭ223 Key Words: anticoagulation Ⅲ antithrombotics Ⅲ atrial fibrillation Ⅲ embolic stroke Ⅲ heart-brain relationships Ⅲ platelet inhibitors Ⅲ prevention Ⅲ prognosis T he burden of atrial fibrillation (AF) and the duration of arrhythmia episodes have never been included in risk stratification schemes because reliance on clinical symptoms and intermittent electrocardiographic assessments can underestimate AF burden. 1,2 Diagnostic features in implantable devices are sophisticated enough to provide reliable information on atrial arrhythmias, allowing data to generate hypotheses on stroke risk stratification. [1][2][3][4] The aim of the study is to test the hypothesis that continuous AF burden monitoring would enhance the sensitivity/specificity of stroke risk stratification schema based on clinical risk factors. MethodsPatients with a dual-chamber pacemaker (Medtronic AT-500) and a history of paroxysmal atrial tachyarrhythmias were included into this study. A day-by-day trend of AF burden (ϭtime spent in AF during each day) was available for each patient during 1-year follow-up with data on minutes/hour spent at high atrial rates. 2 Patients were divided into 3 groups: (1) maximum AF burden Յ5 minutes per day (AF-free); (2) maximum AF burden Ͼ5 minutes but Ͻ24 hours per day (AF-5 minutes); and (3) AF burden of Ն24 hours, the latter considering also the following days (AF-24 hours). Patients were also classified according to the CHADS 2 and the CHA 2 DS 2 -VASc 5 risk scores. A committee of 2 physicians, blinded to AF burden, evaluated the thromboembolic Sensitivity and specificity of each score in predicting TE events, either alone or in combination with AF, were assessed. The number of patients who would require long-term oral anticoagulation therapy (OAC) was calculated according to each combination. Uni-and multivariable logistic regressions were performed considering the CHADS 2 and the CHA 2 DS 2 -VASc scores as continuous variables, whereas AF burden was analyzed by class. For each regression model, the predicted probabilities were used to assess the discriminatory ability of each risk score by means of the C-statistic and its 95% CI. Statistical analysis was made by SPSS (SPSS Inc, Chicago, IL) software, Version 11.5. ResultsData from 568 patients (70Ϯ10 years) were analyzed. Patients were categorized into 3 AF groups: AF-free (nϭ223 [39%]), AF-5 minutes (nϭ179 [32%]), and AF-24 hours (nϭ166 [29%]). In groups AF-free, AF-5 minutes, and AF-24 hours, respectively, asp...

A peak of cardiovascular mortality but not of syncopal recurrences was observed in patients attending to the emergency department for syncope within the first month. Late unfavourable outcomes were caused by associated cardiovascular diseases rather than by the mechanism of syncope. The causes of syncope did not determine the recurrence rate.

Great inter-hospital and inter-department heterogeneity in the incidence and management of syncope was observed in general hospitals. As a consequence, we were unable to describe a uniform strategy for the management of syncope in everyday practice.