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August 1, 2017 Circulation. 2017;136:e60–e122. DOI: 10.1161/CIR.0000000000000499 e98 presumptive diagnosis. In addition to the endpoints of diagnostic yield and healthcare utilization, relevant clinical endpoints of nonfatal and fatal outcomes and recurrence of syncope are to be included. • RCTs are needed to determine the features of syncope-specialized facilities that are necessary to achieve beneficial outcomes for patient care and to improve efficiency and effectiveness of healthcare delivery. • As technology advances, studies are needed to determine the value of new technology in the evaluation and management of patients with syncope. 12.4 Management of Specific Conditions • Although potential causes of syncope are multiple, a treatment decision is usually fairly straightforward for patients with cardiac causes of syncope or orthostatic causes. V VS is the most common cause of syncope in the general population. Treatment remains challenging in patients who have recurrences despite conservative therapy. Studies are needed to differentiate “arrhythmic syncope” versus “nonarrhythmic syncope” versus “aborted SCD” in patients with inheritable arrhythmic conditions. • Prospectively designed multicenter or national registries are needed to gather clinical information from patients with reflex syncope to better our understanding on other associated conditions, plausible mechanisms, effectiveness of therapeutic interventions, and natural history of these uncommon conditions. • RCTs are needed to continue the identification of effective treatment approaches to patients with recurrent reflex syncope. 12.5 Special Populations • Each population in Section 6 is unique with regard to syncope, and within each of them we identified several key areas that are important for future research considerations. • Questions and research about risk stratification, evaluation, and management outlined above for the adult population are needed in the pediatric population, geriatric population, and athletes. • Prospective national registries and big databases are needed to determine risk associated with driving among different populations with syncope. • Prospective and randomized studies are needed to assess the usefulness of specialized syncope units in different clinical settings. ACC/AHA TASK FORCE MEMBERS Glenn N. Levine, MD, FACC, FAHA, Chair; Patrick T. O’Gara, MD, MACC, FAHA, Chair-Elect; Jonathan L. Halperin, MD, FACC, FAHA, Immediate Past Chair*; Sana M. Al-Khatib, MD, MHS, FACC, FAHA; Kim K. Birtcher, MS, PharmD, AACC; Biykem Bozkurt, MD, PhD, FACC, FAHA; Ralph G. Brindis, MD, MPH, MACC*; Joaquin E. Cigarroa, MD, FACC; Lesley H. Curtis, PhD, FAHA; Lee A. Fleisher, MD, FACC, FAHA; Federico Gentile, MD, FACC; Samuel Gidding, MD, FAHA; Mark A. Hlatky, MD, FACC; John Ikonomidis, MD, PhD, FAHA; José Joglar, MD, FACC, FAHA; Susan J. Pressler, PhD, RN, FAHA; Duminda N. Wijeysundera, MD, PhD PRESIDENTS AND STAFF American College of Cardiology Richard A. Chazal, MD, FACC, President Shalom Jacobovitz, Chief Executive Officer William J. Oetgen, MD, MBA, FACC, Executive Vice President, Science, Education, Quality, and Publishing Amelia Scholtz, PhD, Publications Manager, Science, Educa- tion, Quality, and Publishing American College of Cardiology/ American Heart Association Katherine Sheehan, PhD, Director, Guideline Strategy and Operations Lisa Bradfield, CAE, Director, Guideline Methodology and Policy Abdul R. Abdullah, MD, Science and Medicine Advisor Clara Fitzgerald, Project Manager, Science and Clinical Policy Allison Rabinowitz, MPH, Project Manager, Science and Clinical Policy American Heart Association Steven R. Houser, PhD, FAHA, President Nancy Brown, Chief Executive Officer Rose Marie Robertson, MD, FAHA, Chief Science and Medi- cine Officer Gayle R. Whitman, PhD, RN, FAHA, FAAN, Senior Vice Presi- dent, Office of Science Operations Jody Hundley, Production Manager, Scientific Publications, Office of Science Operations FOOTNOTES This document was approved by the American College of Cardiology Clinical Policy Approval Committee on behalf of the Board of Trustees, the American Heart Association Science Advisory and Coordinating Committee, the American Heart Association Executive Committee, and the Heart Rhythm Society Board of Trustees in January 2017. *Former Task Force member; current member during the writing effort. Downloaded from http://ahajournals.org by on October 7, 2026