Guías para el manejo de los desfibriladores automáticos implantables en las fases finales de la vida. Respuesta / Guidelines on the management of implantable cardioverter-defibrillators at the end of life. Response

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Síncope / Syncope

El síncope, definido como una pérdida transitoria de conciencia que cursa con recuperación espontánea y sin secuelas que se debe a una hipoperfusión cerebral general y transitoria, es un cuadro clínico muy prevalente. Esta definición permite diferenciar el síncope de otras entidades que cursan con pérdida de conciencia transitoria, real o aparente, en las que el mecanismo no es una hipoperfusión cerebral, como la epilepsia, las caídas accidentales o el seudosíncope psiquiátrico. Se revisa la clasificación etiológica del síncope, con especial hincapié en que el síncope reflejo es el más frecuente y tiene buen pronóstico, mientras que el síncope cardiogénico aumenta con la edad y tiene peor pronóstico. Se hace una revisión crítica de las principales exploraciones, con especial énfasis en las dudas sobre la interpretación del masaje del seno carotídeo, las limitaciones de la prueba en tabla basculante, la estrategia a seguir en pacientes con síncope y bloqueo de rama, la administración de adenosina y el papel de la monitorización electrocardiográfica prolongada. Asimismo se revisa el estado actual del tratamiento y se destaca la importancia de establecer unidades de síncope con la finalidad de mejorar el proceso diagnóstico optimizando los recursos (AU)

Syncope, which can be defined as a transient loss of consciousness caused by transient global cerebral hypoperfusion and characterised by rapid onset, short duration, and spontaneous complete recovery, is a common condition. This definition is useful for differentiating syncope from other clinical conditions that also involve real or apparent transient loss of consciousness, but in which the mechanism is not global cerebral hypoperfusion, such as epilepsy, falls, or psychiatric pseudosyncope. We reviewed the etiological classification of syncope and found that reflex syncope is the most common etiology in the general population, with a good prognosis, whereas cardiac syncope increases with age and has a worse prognosis. We also reviewed the role and limitations of different tests, specifically referring to the interpretation of the results of carotid sinus massage, the role of tilt-table testing, the diagnostic strategy in patients with syncope and bundle branch block, the adenosine test, and the emerging role of prolonged electrocardiographic monitoring. Furthermore, we reviewed the different therapeutic options available. The importance of establishing syncope units with the aim of improving the diagnostic process and optimizing resources is also emphasized (AU)

Syncope.

Syncope, which can be defined as a transient loss of consciousness caused by transient global cerebral hypoperfusion and characterised by rapid onset, short duration, and spontaneous complete recovery, is a common condition. This definition is useful for differentiating syncope from other clinical conditions that also involve real or apparent transient loss of consciousness, but in which the mechanism is not global cerebral hypoperfusion, such as epilepsy, falls, or psychiatric pseudosyncope. We reviewed the etiological classification of syncope and found that reflex syncope is the most common etiology in the general population, with a good prognosis, whereas cardiac syncope increases with age and has a worse prognosis. We also reviewed the role and limitations of different tests, specifically referring to the interpretation of the results of carotid sinus massage, the role of tilt-table testing, the diagnostic strategy in patients with syncope and bundle branch block, the adenosine test, and the emerging role of prolonged electrocardiographic monitoring. Furthermore, we reviewed the different therapeutic options available. The importance of establishing syncope units with the aim of improving the diagnostic process and optimizing resources is also emphasized.

Manejo de los pacientes con síncope: de las guías a la práctica clínica / Management of patients with syncope: from guidelines to clinical practice

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Radiofrequency catheter ablation of an accessory pathway through an anomalous inferior vena cava with azygos continuation.

A 59-year-old man with Wolff-Parkinson-White syndrome and an infrahepatic interruption of his inferior vena cava with an azygos continuation underwent a successful ablation of a right anteroseptal accessory pathway with a femoral approach through the azygos vein and superior vena cava.

La prueba en tabla basculante en el síncope vasovagal: ¿para qué?, ¿a quién? / Head-up tilt test in vasovagal syncope: for which purposes? for whom?

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