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1 REVIEW ARTICLES Received: June 21, 2018 Accepted: June 29, 2018 Corresponding Authors: * The first two authors contributed equally to this work. Two authors contributed equally to this work as corresponding author Copyright 2018 The Official Journal of Korean Heart Rhythm Society Editorial Board ABSTRACT The general concept and initial approach to syncope patients have been mentioned in the general sections. This special section describes the clinical characteristics, diagnosis, patient education and treatment for the each syncope. The contents are in order of reflex syncope, orthostatic hypotension, postural orthostatic tachycardia syndrome (POTS), cardiac syncope, and unexplained syncope. Several clinical issues will have been dealt with in special issues. Neurological assessment is added when the patients were diagnosed with psychogenic pseudosyncope (PPS). Although most of syncope in children and adolescents is reflex syncope, they may be caused by cardiovascular events in patients with congenital heart disease. In the elderly patients, syncope occurs not only by a single cause but a combination of various conditions. When they visit the emergency department, a standardized systematic approach is required to determine whether hospitalize them according to the risk and the needs for the specialized syncope management. We also described the limitations put on driving, exercising and social life style that are relevant to syncope. In this guideline, we also reviewed the Korean published literatures and European/American guidelines on syncope. American College of Cardiology ACC American Heart Association AHA Arrhythmogenic right ventricular cardiomyopathy/dysplasia ARVC/D Atrioventicular block Atrioventricular nodal disease Autonomic nervous system Bifascicular block Benefit/risk ratio Brugada syndrome 145

2 Bundle branch block Cardiac syncope Cardiac output Cardioinhibitory Cerebral hypoperfusion Cascade Class of recommendation COR Cognitive behavioral therapy Compression garments Conduction system delay Conversion disorder Convulsive syncope Counter-pressure maneuver Cyanotic breath holding spell Early repolarization Ejection fraction Electrophysiological study EPS Emergency department observation units EDOU Epilepsy European Heart Rhythm Association EHRA European Society of Cardiology ESC Fludrocortisone Hazard ratio Head-up tilt test HUT Heart Rhythm Society HRS Hypertrophic cardiomyopathy Implantable cardioverter defibrillator ICD Implantable loop recorder ILR Ischemic cardiomyopathy Isometric contraction Korean Heart Rhythm Society KHRS Korean Society for Holter and Noninvasive Electrocardiology KSHNE Left cardiac sympathetic denervation 146

3 2018 KHRS guideline for the evaluation and management of syncope Leg crossing Level of evidence LOE Long QT syndrome Loss of consciousness LOC Mineralocorticoid Multiple systemic atrophy Neurally mediated syncope NMS Neurodegenerative disorder Neurogenic orthostatic hypotension Orthostatic hypotension OH Postural orthostatic tachycardia syndrome POTS Pre-excited QRS complexes Primary electrical disease Psychogenic pseudoseizure Psychogenic pseudosyncope PPS Psychogenic transient loss of consciousness Psychogenic non-epileptic seizure PNES Reflex syncope RS Sinus node disease Sinus node recovery time SNRT Situational syncope Squatting Subarachnoid hemorrhage Sudden cardiac death Syncope Syncope management unit Syncope unit Tonic clonic seizure Transient ischemic attack TIA Transient loss of consciousness TLOC Tunnel vision Unexplained syncope Vasodepressor 147

4 Vasovagal syncope VVS Venous return Vertebrobasilar insufficiency Video-EEG monitoring 1. Class of Recommendation (COR) Class of recommendation ClassI Class II Class IIa Class IIb Class III Definition Evidence and/or general agreement that a given treatment or procedure is beneficial, useful, effective. Conflicting evidence and/or divergence of opinion about usefulness/efficacy of the given treatment or procedure. Weight of evidence/opinion is in favor of usefulness/efficacy. Usefulness/efficacy is less well established by evidence/opinion. Evidence or general agreement that the given treatment or procedure is not useful/effective, and in some cases may be harmful. 2. Level of Evidence (LOE) Class of recommendation Level of Evidence A Level of Evidence B Level of Evidence C Definition Data derived from multiple randomized clinical trials or meta-analyses. Data derived from a single randomized clinical trial or large nonrandomized studies. Consensus of opinion of the experts and/or small studies, retrospective studies, registries. 148

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23 2018 KHRS guideline for the evaluation and management of syncope LOC, loss of consciousness; OH: orthostatic hypotension, VVS: vasovagal syncope 167

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